Circumcision as conquest: Masculinity in Eswatini’s voluntary medical male circumcision campaign materials

ABSTRACT

As a public health intervention related to sexual transmission and involving genital surgery, male circumcision for HIV prevention necessarily relates to understandings of sexuality and gender, a relationship which public health campaign materials have shaped in varying ways. Here, I employ discourse analysis to examine messages about gender and sexuality in Eswatini’s Soka Uncobe (Circumcise and Conquer) public health campaign for voluntary medical male circumcision (VMMC). The slogan 'conquest' echoes nationalist imagery and extends throughout campaign materials, such as in a comic book presenting the circumcising man as a hero vanquishing an enemy. Elsewhere, campaign materials use the slogan to link sexual conquest to the conquest of HIV in a move that is misleading and potentially harmful. As with several circumcision campaigns in the region, messages about the HIV protection offered through the intervention and the limits to this protection are minimal and are overshadowed by a framing of circumcision as a newly necessary norm for appropriate masculine citizenship and sexuality. This consideration of the positioning of gender, sexuality, and sex in campaign materials promoting VMMC is pertinent to the global public health effort to reduce HIV transmission, particularly given the social complexities at stake in the context of sexual transmission.

KEYWORDS:

• VMMC
• circumcision
• HIV prevention
• Eswatini
• gender

Introduction

This article examines messages about gender and sexuality in Eswatini’s Soka Uncobe (Circumcise and Conquer) public health campaign materials promoting male circumcision as HIV prevention. The campaign positions the circumcising adult man as a conquering hero in messages that relate to three areas of masculinity: patriotic citizenship, patriarchal protection of family, and sexual desirability. While attempting to brand getting circumcised as a particularly Swazi form of masculine responsible citizenship, the campaign largely overlooks the concerns Swazi men have with the intervention. The campaign variously positions Swazi women as the targets of sexual conquest or as in need of male protection. Tying circumcision to an idealised masculinity is in keeping with a ‘demand creation’ approach to the intervention, an approach that I and other critical health scholars have critiqued elsewhere (Mkhwanazi, 2020; Rudrum, 2020). The attempt to position circumcision as part of a desirable form of masculinity suffers from a lack of connection, in this instance, to existing social contexts in Eswatini surrounding gender, sexuality, and relatedly, sexual transmission of HIV. Public health campaigns attempt to engage their audience and promote change through drawing attention to social and individual dimensions of a public health problem. In this article, I attend to how the these are framed in the Soka Uncobe (Circumcise and Conquer) Voluntary Medical Male Circumcision (VMMC) campaign. Offering a critical reading of how gender and sexuality are presented in the campaign contributes to medical sociology and to critical public health in two main ways. It contributes to an ongoing discussion of how public health campaigns engage with existing or aspirational norms surrounding gender, masculinity, femininity, sex, and sexuality, building on the recognition that a range of messaging from harmful to transformative in public health does have real world effects (Chong & Kvasny, 2007). It also contributes to the literature on male circumcision as HIV prevention, an intervention which, despite the optimism and investment present in global health responses to clinical trials, nevertheless remains both culturally and biomedically fraught (Bell, 2015; Dowsett & Couch, 2007; Johnson, 2015; Martínez Pérez et al., 2015).

Background

VMMC in sub-Saharan Africa and Eswatini

Voluntary medical male circumcision (VMMC) as HIV prevention is being promoted in sub-Saharan countries that have high rates of HIV and low existing rates of circumcision. The intervention was introduced as a World Health Organisation recommendation in response to clinical trial data identifying an HIV prevention rate of 53-60% for males via circumcision, (Auvert, 2005; Bailey, 2007; Gray et al., 2007). Eastern and Southern Africa have been the focus of the push to promote VMMC, with programs initiated in fourteen countries that have high rates of HIV but low existing rates of circumcision. However, circumcision as HIV prevention is not a magic bullet (Bell, 2015): circumcision offers no direct prevention to women (Harrison, 2014; Padian et al., 2011; Wawer et al., 2009) and offers incomplete protection to men. Women are disproportionately affected by the virus throughout the region, meaning that prevention efforts that can target women will be particularly impactful, but, in the case of circumcision, while an indirect HIV protection benefit to women is hypothesised, it may ‘be slow to emerge and have limited impact […] in the short term’ (Maughan-Brown et al., 2014, p. 1171). Because women are not directly protected and because the protection afforded to men is incomplete, there is a continued need for behavioural prevention strategies, such as condom use and minimising the number of sexual partners, post-circumcision. The decision whether or not to circumcise is less than straightforward for men in the target countries. However, the targets set are ambitious: the public health intervention campaigns aimed to circumcise 80% of adults (Njeuhmeli et al., 2011).

Eswatini, then Swaziland, became a target country for VMMC due to high HIV rates and a low circumcision rate (about 8% [Mkhwanazi, 2020]), as circumcision was not traditionally practiced. Despite declining rates of HIV, Eswatini has the world’s highest HIV prevalence, at 26% (Maibvise & Mavundla, 2014; Mkhwanazi, 2020). These rates represent a public health emergency; efforts at reducing transmission in the country are crucial. In Eswatini, as elsewhere in sub-Saharan Africa, heterosexual sex remains the primary mode of HIV transmission (UNAIDS, 2018) and women are disproportionately affected. Men, masculinity, and male sexuality have been frequently framed as the problem in public health programming, as has culture itself (Bell, 2015). However, Adams et al. (2021) note that a simplistic aggressor-victim account of gendered sexual relations and sexual transmission of HIV likely neglects men’s vulnerabilities, such as structural barriers to safer sex and to health services. Within this context, interventions related to sexual transmission of HIV and sexuality more broadly are at once important, due to their potential to reduce rates of transmission, and fraught, due to the complex social relations within which sexual transmission occurs.

Methods

In order to examine the representation of gender and sexual relationships and the presentation of health information in public health campaigns in Africa, I undertook a discourse analysis of campaigns promoting circumcision in sub-Saharan Africa. The campaign materials in Eswatini discussed in this article were identified during this study on VMMC in the region.

Discourse analysis is an interdisciplinary approach to ‘language use as social practice’ (Fairclough, 1995, p. 131) that traces the dialectical relationship between power and discourse as they co-constitute each other. As a methodology, discourse analysis offers a way to examine ideologies as they produce and reproduce unequal social relations (Fairclough, 1995), including in health and health care. Deborah Lupton argues that because public health seeks to ‘understand health and illness in their sociocultural context’, discourse analysis offers a powerful contribution through its ability to elucidate ‘the complex relationships between the audience and text’ (Lupton, 1992, p. 149). In particular, feminist discourse analysis ‘can show up the complex, subtle, and sometimes not so subtle, ways in which frequently taken-for-granted gendered assumptions and hegemonic power relations are discursively produced, sustained, negotiated and challenged in different contexts and communities’ (Lazar, 2007, p. 142). In identifying how messages about appropriate gender and sexuality are produced, disseminated, and taken up, discourse analysis is concerned with the social reproduction or interruption of gender and sexuality norms. In this study, I am particularly concerned with how masculinity, femininity, gender relations and acceptable sexuality are configured within public health campaign materials promoting VMMC.

Working with a research assistant, I identified campaign materials for VMMC shared publicly on sources such as the clearing house on male circumcision. During an eight-month period in 2018–2019, we identified materials produced for dissemination in twelve countries: Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, South Africa, Eswatini (then Swaziland), Tanzania, Uganda, Zambia and Zimbabwe. We did not retain any materials where no funding or publication sources was available We collected an array of campaign materials, most commonly posters but also newspaper ad strips, newspaper testimonials, television and radio spots, billboards, branded condoms, instructional flip charts, and campaign background documents. Details of the number and type of material selected are available in a previous article (Rudrum, 2020). Many campaign materials were presented in English (often in addition to other languages). When analyzing campaign materials produced in languages other than English, I relied on campaign background documents which included translations of slogans and dialogue. As such, I rely on published English translations of some materials.

While previous work has focused on the campaigns overall (Rudrum, 2020), this article focuses on the materials used in Eswatini’s Soka Uncobe (Circumcise and Conquer) campaign. These materials include one narrative comic book titled My Journey to Circumcision, two posters, three drink coasters, and one branded condom wrapper. Data analysis was inductive. After reviewing campaign materials, I worked to identify messages related to sex, sexuality, and health benefits. I imported campaign materials into the qualitative data software NVivo and coded the material, identifying repeated themes related to gender, sexuality, and health. My analysis draws on feminist discourse analysis as described above, also introducing critiques related to colonial health practices and racialisation.

Findings and discussion: masculinity messaging

The Soka Uncobe campaign and the circumcision initiative in Eswatini (then Swaziland) was funded by USAID and supported by a range of international and national groups from the World Health Organisation to the Ministry of Health. This initial roll-out of circumcision has been acknowledged as a failure on various counts (Adams et al., 2021; Adams & Moyer, 2015; Maibvise & Mavundla, 2014). Previous studies have reflected on the campaign’s failure to meet the internal metric of number of men circumcised (Adams & Moyer, 2015) and identified issues with consent to the procedure (Moyer et al., 2022). The Swazi medical anthropologist Nolwazi Mkhwanazi (2020) has argued that the focus on targets, metrics, and speed in fact contributed to the campaign’s failure; the metrification of global health intervention has been the site of recent critical work in anthropology (Adams, 2016; Biruk, 2018). While the goal was to circumcise 152,000 adult men during a 12-month accelerated saturation initiative, only about 11,000 circumcisions were performed (Mkhwanazi, 2020). Mkhwanazi provides an account of the way in which local expertise and experience was sidelined in favour of a global health approach generated elsewhere, arguing that this neglect of context contributed to the campaign’s failure to live up to what she terms as the ‘dreams’ of the implementers. Here, I examine whether there is an additional site of failure, located in the campaign materials’ discourses and representations of gender and sexuality. Public health messages impact social relations and understandings of health, both within their target intervention, in this case HIV prevention, and beyond their target intervention, in other social or medical sites. Medical sociology is concerned with the ‘effects of health promotion efforts, including how they create and legitimise definitions of gender and sexuality, configure interventions and affect ‘target’ populations and broader social systems’ (Esacove, 2013, p. 33). I argue that the campaign, as well as introducing an HIV prevention strategy, introduces or reifies harmful discourses about sexuality, gender and power. This analysis extends my work on male circumcision campaigns in other national contexts in the region (Rudrum et al., 2017).

The campaign introduced in Eswatini had the slogan, Soka Uncobe, or Circumcise and Conquer, associating circumcision with male conquest. As with some other VMMC campaigns, the campaign materials use images, text, and narrative to create connections between circumcision and an aspirational masculinity (Rudrum, 2020; Rudrum et al., 2017). Campaign materials included condom wrappers, bar coasters, and a comic book. Throughout the campaign, conquest offers a double entendre: the circumcised penis is positioned as a route to sexual conquest, while the man who is circumcised is framed as heroic in conquering the enemy, HIV, and being a warrior in relation to his nation. These narratives draw, to an extent, on existing cultural narratives of masculinity: the Swazi flag features a shield and spear as warrior symbols, for example, and HIV is a known threat. Beyond a straightforward promotion of circumcision as a means of reducing HIV transmission in the population, however, the campaign materials attempt to reconfigure masculinity such that, in a non-traditionally circumcising culture, circumcision would be understood not only as protective against HIV but also as necessary to successful masculinity. This narrative of heroism and conquest is extended in the campaign to three main sites of masculinity: patriotic citizenship, patriarchal protection of family, and sexuality. These areas are linked, such as in the campaign logo which features a masculine, broad-shouldered silhouette in a triumphant position, standing in the centre of a sunburst and the messages ‘I conquer the Swazi way. I circumcise, I condomise’ and ‘We men hold the future of Swazi in our hands. Our women are depending on us’.

Masculinity can be understood as constituted through culturally endorsed understandings of male roles and behaviours associated with normative male power (Adams et al., 2021). Masculinity is necessarily entangled with circumcision; however, campaigns can approach this relationship in various ways. Paying attention to the particular modes of masculinity that are valorised within the campaign elucidates how VMMC campaigns interact with existing narratives and norms around gender and sexuality. While narratives on patriotic masculinity, patriarchal masculinity, and sexualised masculinity are linked in the campaign materials, I explore them in three separate sections below.

Circumcision as masculinity through patriotic citizenship

Messages on masculinity in the campaign were linked to three main aspects of manhood, each positioned as attainable through circumcision: patriotic nationality, patriarchal protection of family, and sexual performance. Conquest, as featured in the campaign slogan, echoes national symbols, such as the shield and spears of the flag, and extends throughout campaign materials. Prominently, a comic book titled My Journey follows the Swazi praise singer Msandi Kababa as he considers, and ultimately seeks out and undertakes, circumcision. The comic book presents the circumcising man as a hero vanquishing an enemy, HIV. A double entendre is employed such that association between circumcision and sexual conquest is also present, reaffirming norms that connect male sexuality to dominance and objectification of women in a move that is misleading and potentially harmful within the context of HIV prevention. As discussed below, the masculine attributes invoked in the campaign do not address the anxieties articulated by Swazi men in relation to circumcision, anxieties identified by qualitative and ethnographic studies focusing on the intervention’s reception and men’s feelings about circumcision (Adams & Moyer, 2015; Mkhwanazi, 2016).

The Soka Uncobe campaign involves a nationalist, patriotic rhetoric which is framed as a return to African tradition, depicted expansively. The campaign comic book, which presents the ‘hero’ cloaked in a printed cloth and necklace, frames circumcision as traditional. He declaims, ‘The benefits of circumcision are ancient wisdom in many African cultures. I need this protection now more than ever. I must be a man and protect my family’. While circumcision is part of cultural tradition in many African groups, that has not recently been the case in Swaziland, where circumcision rates were 8% before the intervention (Mkhwanazi, 2020, p. 132). Therefore, the link proposed between circumcision and being a good Swazi man is a new one, and perhaps unconvincing to Swazi men amid a rapid rollout of the intervention. In contrast, elsewhere in Africa, circumcision as good citizenship is presented in VMMC campaign materials as modern and a sign of progress, as Malawi’s Ndife Otsogola campaign whose slogan is ‘we are forward thinking’. Such inconsistencies in claims are a result of the demand creation approach, in which whatever narrative is projected to be influential is shared.

The comic book employs an extended metaphor of battle in which HIV is positioned as the enemy and the circumcising man is a courageous hero. Men are featured primarily in relation to their male peers, who are either circumcision mentors or detractors. Women as partners or lovers are entirely absent, with a woman featuring only briefly as a health administrator. As in Uganda’s Stand Proud, Get Circumcised campaign (Rudrum et al., 2017), pride is invoked, although the linking of nationalism to family fealty is particular to the Soka Uncobe campaign. This is demonstrated when the medical professional asks ‘any pain?’ and the patient, Msandi Kababa replies ‘No. I feel like a hero doing battle with my proud family behind me’ and later when the health worker states ‘you look very happy and proud!’ and Msandi Kababa responds ‘I am! I am! I did this for myself, my family and my country. I feel like a warrior!’ This draws on hegemonic notions of masculinity but attempts to update the idea of warrior to include circumcision. Here, attention to cultural values, such as a tradition of understanding Swazi men as warriors, is mixed with an attempt to override other cultural norms, positing circumcision as traditionally ‘African’ despite it not being a recent Swazi cultural or medical practice.

Circumcision as good masculinity through patriarchal protection of family

The connection between circumcision, family, and country is echoed elsewhere in the Soka Uncobe campaign, generally with men positioned as the head of the family and the protector, with circumcision contributing to this role. An exception occurs in a poster featuring a woman with three male family members and text that reads (in part) ‘be a good Swazi mother and do your part to insure your family’s good future’. Here, promoting circumcision to one’s partner and teens becomes the role of the good mother. For men, a normative family role extends to the protection of women. Such a role is presented in the campaign in ways that confuse how circumcision works and overlaps with messages of sexual conquest as a form of virility.

Men’s patriotic and patriarchal role as protector is depicted on a condom featuring the message ‘We men hold the future of Swazi in our hands. Our women are depending on us’. In fact, as mentioned, circumcision does not directly benefit women and the timeline and extent of a projected indirect benefit was unknown at the time of the intervention. The intervention also offers some protection against HPV and related cancers, including cervical cancer. However, since the primary purpose of introducing VMMC is to reduce HIV transmission, it is likely that messages that the procedure protects women or benefits everyone will be misinterpreted as implying that women are protected from HIV via the procedure. The confused message on who can benefit from the procedure and to what extent is reiterated in bar coasters featured in the campaign whose text reads in part: ‘Male circumcision benefits everyone. VMMC reduces your chances of getting HIV during sex – doesn’t provide 100% protection’. Because the coasters are designed for a mixed gender environments such as bars or clubs, and feature women as well as men, it is not clear that the implied you here is male, and the rates of protection to men are not clear because they are not provided. In Malawi, a study of ‘whether individuals who learn that male circumcision reduces female-to-male HIV transmission also erroneously infer a reduction in direct male-to-female transmission risk’ identified that a direct protection to women was indeed inferred (Maughan-Brown et al., 2014, p. 1170), suggesting that if the intervention is to be understood identification its limitations is necessary.

The male-as-protector trope exists alongside messages linking virility to sexual conquest in the campaign. Using condom wrapper branding as part of the campaign, and using a slogan ‘circumcise and condomise’, helps promote understanding that behavioural change such as condom use remains necessary. However, other behavioural strategies for reduced transmission are omitted in favour of positioning circumcision as aiding sexual virility or desirability. The hero conquering HIV, the nationalist warrior, and the sexual hero operate together via the slogan ‘I conquer’, which also appears on branded condoms, tying sexual conquest to the conquest of HIV in an apparent contradiction. This leads to questions on risk compensation. Risk compensation is the potential that feeling protected can lead to more risk taking, and in this case, the potential that circumcision might lead men to believe they can safely have more sexual partners, or women to believe that they can safely sleep with a circumcised partner without barrier protection. The extent of risk compensation resulting from circumcision is unknown (Kalichman et al., 2007); however, messaging on sex and risk is likely to shape the presence and extent of risk compensation.

Sexuality: virility or fragility

In the campaign, a circumcised penis is positioned as desirable to women and therefore sexy. The accuracy of this message, produced in an attempt to generate male demand for the procedure, may be beside the point. However, for the target group, adult men, sexual sensation and performance were important questions, questions that were handled in the campaign in a knowing, nudging way that reiterated the untested claim that women would prefer a partner with a circumcised penis.

The Soka Uncobe campaign comic ‘My Journey’ includes in a list of circumcision myths the idea that ‘you will never enjoy sex again’. When this and other myths (‘I heard you can’t get into heaven’) are answered through ‘facts’ by ‘experts’ who have been circumcised, the fear of losing sexual pleasure is rejoindered by a man stating ‘my wife is happier than before if you know what I mean’. In this dialogue, male sensitivity is implicitly traded for female sexual pleasure. Female approval for the circumcised penis is also portrayed in Soka Uncobe bar coasters mentioned above. One has the slogan ‘lisoka lisoka ngekusoka’ meaning ‘the lover boy is a lover boy thanks to circumcision’, while another features a smiling woman asking ‘is yours new and improved?’ and giving a thumbs up, beside a man opening the waist of his pants and looking down. This attempts to link circumcision to an idealised body aesthetic and to sexual performance. However, women’s purported pleasure in the aesthetic or performance of circumcised men and the promise of sex and desirability may not be seen as an adequate trade-off for decreased sexual sensation. This was true for a participant quoted by Adams et al. (2021), who felt he lost both sensation and masculinity due to the procedure and whose narrative situated: ‘sexual desirability by women … [as] not outweighing the perceived loss of masculinity’ (p. 7). These concerns about sexual sensitivity, the ongoing need for behavioural protection such as condom use, and fears over potential loss of function due to surgical error, alongside features of the rollout such as its speed and apparent wealth contributed to low uptake (Adams & Moyer, 2015; Mkhwanazi, 2020). Despite such concerns, anxieties around sexual sensation, to the extent that they are acknowledged in VMMC campaigns, tend to be reframed such that women’s purported sexual and aesthetic pleasure at the circumcised penis is centred and the question of male loss of sensation is sidestepped. For example, Uganda’s campaign featured attractive women with the slogan, ‘forget size, you mean you’re not circumcised?’ (Rudrum et al., 2017). While male reluctance to circumcise has been positioned as a cultural barrier to overcome, Mkhwanazi points out that it can also be read as a rational response despite the assumption that men would ‘unquestioningly and unequivocally accept the notion that they should be circumcised as this may prevent them from acquiring HIV’ (2020, p. 145, emphasis in original).

The implied sexual agency of the woman in the bar coaster who asks about the man’s penis implies a dynamic in which women call the shots when it comes to sex. Such a dynamic would be useful to leveraging ideas about female pleasure to sell circumcision. However, female sexual agency in the Swazi context, as elsewhere, is constrained in several ways. Coercion in girls’ first sexual encounter – ‘non-consensual sexual debut' – occurs frequently, with a 2007 finding that 15% of girls were persuaded or tricked and 5% were raped (Reza et al., 2007). Transactional sex is also relatively prevalent. The way these and other inequitable gendered relations organise sex and sexual relationships, and the biology of transmission, contribute to women’s disproportionate vulnerability to HIV. While circumcision is an intervention in which only men can directly participate, and which only directly benefits men, both men’s and women’s lives can be affected by this health intervention. The relational context of HIV needs to be better taken into consideration in the campaigns.

The details on the protection rates offered to men and the question of whether women are protected remain blurry in the campaign materials. This is true even in longer pieces such as comic books, where space restraints are not a concern. For example, the comic ‘My Journey’ goes into great detail about the procedure, even down to what happens to the foreskin upon removal: ‘Goodbye foreskin. Our hero is a safer man without you’. However, details about HIV prevention are lacking: the comic states that protection is ‘not 100%’, which is unnecessarily vague when there are clear numbers that could be cited: 53-60% according to the clinical trials (Auvert, 2005; Bailey, 2007; Gray et al., 2007). The comic states that circumcision protects ‘you’ from HIV, and is targeted towards men; however, it does not explicitly state that women are not protected. As noted above, this ‘you’ language is also used on bar coasters for mixed sex spaces, which further contributes to the potential for misunderstanding how circumcision works. Like some other campaign materials, the comic book includes the logo ‘circumcise and condomise’, but otherwise doesn’t address safer sex following circumcision. Instead, with a graphic of Msandi standing, arm raised in a position of victory, on a dead dragon, with the text ‘The monster is conquered. Msandi stands proudly on top of the lifeless belly of his opponent’. Positioning circumcision as a onetime intervention that defeats the foe, HIV, neglects important information about the ongoing need for safer sex facilitated through behavioural interventions. This tendency to sidestep the social, explored by Kirsten Bell in her 2015 article ‘Making Circumcision the Right Tool for the Job’, stems in part from a valorising of a technological solution, yet, in this instance, cultural tropes are deployed to rewrite the sociality of masculinity instead of focusing on the technological or science case for circumcision. With so much attention to masculinity in the campaign materials, however, in both the campaign materials analyzed here and in the rollout itself ‘little consideration was being given to the concerns of the men’ (Mkhwanazi, 2016, p. 200).

Men’s concerns about circumcision have previously been identified by qualitative researchers including in the Swazi context. Barriers to the uptake of circumcision include men’s fear related to loss of sexual sensation, diminished sexual performance, or injury to the penis (Adams & Moyer, 2015; Maibvise & Mavundla, 2014; Mkhwanazi, 2016, p. 200). The circulation of regrets over loss of sensation are a factor in some Swazi men deciding against the procedure (Adams & Moyer, 2015, p. 728). A 2014 study by Maibvise and Mavundla found that fear of ‘reduced sexual vigour’ was a strike against circumcision for participants, noting that existing research on the connection between circumcision and both male and female sexual pleasure is inconclusive but suggests that male orgasm tends to be delayed among circumcised men. The celebratory discourse of virile masculinity present in the campaign materials does not address these material concerns about function.

Conclusion

While the goal of the Soka Uncobe campaign is to promote the uptake of circumcision, its messaging suffers from a lack of connection to social contexts of gender, sexuality, and transmission. The aspirational masculinity presented in the campaign does not address masculinity-linked worries as identified in existing literature, including loss of sensation (Adams et al., 2021; Adams & Moyer, 2015), cultural and religious practices related to bodily integrity and the disposal of the foreskin (Adams & Moyer, 2015; Mkhwanazi, 2020), or loss of income (Adams et al., 2021). Instead, the messaging potentially reifies male sexual aggression/entitlement, a caricature of male sexuality that reproduces existing gendered power disparities in relation to sex, in ways can be harmful to men and women. While biomedical interventions are often positioned as science-based and outside of culture, their authority ‘common sense’ (Wendland, 2010, p. 12), scrutiny of the globalised culture of HIV prevention campaigns is as relevant as the repeated scrutiny of the sexual cultures of the ‘locals’. A close examination of campaign materials demonstrates that alongside circumcision, another intervention was being promoted, one that attempted to reconfigure not only the penis but also the culture of masculinity. The relationship of masculinity to nation and family as well as femininity and female sexual partners was being redrawn. Given the sexual nature of transmission as well as questions of gender equity, attention to the depiction of gender and sexuality in future campaign messaging will be relevant.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by Acadia University’s Research Fund.