“There's evidence that this really works and anything that works is good”: views on the introduction of medical male circumcision for HIV prevention in South Africa

Abstract

Three clinical trials have demonstrated the partial efficacy (40–60%) of surgically conducted medical male circumcision (MMC) in preventing HIV transmission to circumcised men. This research formed part of a larger study exploring the importance of integration of sexual and reproductive health with HIV services. The objective was to elicit key informant views on the introduction of MMC for HIV prevention in South Africa. Twenty-one key informants representing the South African Health Department, local and international NGOs and universities, were asked, via semi-structured interviews about their views on introducing MMC as an HIV prevention strategy in South Africa. Interviews were transcribed and all discussions on MMC were coded for analysis using NVivo 8. The majority of the key informants were knowledgeable about MMC for HIV prevention and felt that making MMC available in South Africa was a good idea, with some recommending immediate introduction. Others felt that MMC should be introduced with caution. Various factors were recommended for consideration, including culture, the impact of circumcision on women, possible increase in sexual risk behaviour from behavioural disinhibition and that MMC may become another vertical health service programme. Most felt that MMC should be undertaken in neonates, however, acknowledged concerns about cultural responses to this. Recommendations on the implementation of MMC ranged from integrating services at primary health care level, to provision by private medical practitioners. In conclusion, MMC is viewed as a key HIV prevention strategy. However, there are numerous factors which could hinder introduction and uptake in South Africa and in the region. It is important to explore and understand these factors and for these to be aligned in the national MMC policy.

Keywords:

• medical male circumcision
• HIV prevention
• integration of services
• South Africa

Acknowledgements

The authors would like to thank Kathryn Church for her assistance with data collection and analysis. The authors would also like to thank the respondents for their time and invaluable input to this research. The authors of this article are supported through funding from William and Flora Hewlett Foundation; and the US President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR was made possible by the support of the American people through the United States Agency for International Development (USAID). The contents of this article are the sole responsibility of MatCH (Maternal, Adolescent and Child Health) and do not necessarily reflect the views of USAID or the United States Government.

Notes

1. This is when only part of the foreskin is removed during circumcision.

2. In most cases, cultural circumcision is partial. Only full circumcision has been shown to be effective in reducing transmission of HIV to the circumcised person.