Towards a context-specific understanding of masculinities in Eswatini within voluntary medical male circumcision programming

Abstract

Compelling evidence from three randomised controlled trials, which showed that voluntary medical male circumcision (VMMC) reduces HIV acquisition from women to men by up to 60%, led to WHO recommending that VMMC be implemented in 14 priority countries. As one of the priority countries, Eswatini aimed to reach 80% VMMC coverage among boys and men aged 10–49 years since programme inception in 2009. By the end of 2019, however, the country had reached a modest 40%. VMMC is intrinsically tied to perceptions of masculinity and male gender identity. Comprehending the role of context-specific masculinity as it relates to VMMC may contribute to our understanding of community attitudes towards VMMC and men’s decision-making. Drawing on focus group discussion data, this study aimed to explore the linkage between sexuality, masculinity and health interventions within Eswatini. Using critical discourse analysis, the study identified two discourses: sexuality, masculinity and circumcision, and income, masculinity, and circumcision. In the first discourse, participants constructed discursive linkages between circumcision as an adult and loss of penile sensitivity, decreased libido and sexual performance, and adverse events. The second discourse, income, masculinity, and circumcision located circumcision within the social and material realities faced by Swazi men, gender norms and provision within family structures.

Keywords:

• Male circumcision
• Eswatini
• masculinity
• HIV prevention

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Tinkhundla is a local term for constituencies. Inkhundla is an administrative subdivision below the four regions and the country has 59 tinkhundla.

2 Shisa nyama is a place where barbequed meat is sold, and people usually congregate for food and beverages. Locally this is also known as a braai area.

3 Mzimbomubi has no Western medical or English language equivalent. Instead, mzinbomuni is a traditional Swazi understanding of a condition from which an individual heals slowly, is prone to infection and has other poor healing outcomes for both minor and severe injuries. The condition is related to age. The literal translation is “bad body” or “ugly body”.

4 Within this context, communitas may be defined as the collective agency or oneness experienced when a group, such as men in a specific context, works towards a shared goal (See Turner, 2012).