Ethnic identity, region and attitudes towards male circumcision in a high HIV-prevalence country

Abstract

We study how considerations of male circumcision (MC) as both a favourable practice and as protective against HIV are linked with ethnicity in sub-Saharan Africa, where many ethnic groups do not traditionally circumcise. We focus on Malawi, a country with a high HIV prevalence but low MC prevalence. Survey data from a population-based random sample in rural Malawi (N =3400) were analysed for ethnoregional patterns in attitudes towards MC. We used logit regression models to measure how reported circumcision status, region of residence and ethnic identity relate to attitudes towards circumcision. Overall, Malawians reported more negative than positive opinions about MC, but attitudes towards circumcision varied by ethnicity and region. The implications for agencies and governments aggressively scaling up the provision of MC are clear; acceptance of circumcision as a tool for HIV prevention could be low in societies divided by ethnoregional identities that also shape the practice of circumcision.

Keywords:

• HIV/AIDS
• male circumcision
• ethnicity
• attitudes
• Malawi

Acknowledgements

The collection of data analysed in this article was supported by NICHD R01 grant #RHD053781 (Principal Investigator: Hans-Peter Kohler). Shikha Bedi, Lynn Hancock, Amy Polglase and Mindy White provided excellent research assistance. Susan Watkins and Anna West gave helpful feedback on an earlier draft. The authors also acknowledge helpful comments from anonymous reviewers. All errors or omissions are the authors’.

Notes

1. Historically, adolescent male Yao became circumcised as part of initiation ceremonies, but not always consistently. However, with the colonisation of the British and the Yao history of trading with Arabic peoples, many Yao leaders decidedly made MC a part of Yao tradition in defiance of British invasion (Bone, 1982). Today, although most Yaos are Muslim and circumcision is viewed as important to the religion of Islam, Malawians primarily identify MC as an ethnic characteristic.

2. Attempts were made to interview all respondents for both surveys, but in some cases respondents were absent when one of the surveys was fielded.