ABSTRACT
In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.
Acknowledgements
The authors would like to gratefully acknowledge Maggie Nkgau and Spencer Manthe for their assistance in recruitment of study participants and transcription of audio recordings.
Disclosure statement
No potential conflict of interest was reported by the authors.
Conflicts of interests
All authors declare that no conflicts of interest exist.
Funding source
This work was supported by the President's Emergency Plan for AIDS Relief (PEPFAR), through funding to the University of Washington and I-TECH from the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) Global HIV/AIDS Bureau under Cooperative Agreement No. U91HA06801.