{"id":1001,"date":"2014-06-23T15:49:52","date_gmt":"2014-06-23T15:49:52","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1001"},"modified":"2014-06-18T12:50:26","modified_gmt":"2014-06-18T12:50:26","slug":"cultural-constraints-on-the-uptake-of-voluntary-medical-male-circumcision-in-eastern-and-southern-africa","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2014\/06\/23\/cultural-constraints-on-the-uptake-of-voluntary-medical-male-circumcision-in-eastern-and-southern-africa\/","title":{"rendered":"Cultural constraints on the uptake of voluntary medical male circumcision in Eastern and Southern Africa"},"content":{"rendered":"

My previous blog spoke of the recent PLoS-Medicine Collection on the progress of a UNAIDS initiative for a five-year scale-up of Voluntary Male Medical Circumcision (VMMC) for HIV prevention in 14 high priority Eastern and Southern African countries.\u00a0 Among the papers, Ashengo & Njeuhmeli<\/a> (A&N) and Macintyre & Bertrand<\/a> (M&B) deal with what the authors of the Collection Review identify as one of the two major obstacles to deployment of the initiative: the insufficiency of demand, especially amongst older (aged 25+) men.\u00a0 They consider the cultural and social constraints on demand, as these are reflected in the very different cultural contexts of Zimbabwe and Tanzania\/Iringa Province (A&N) and Kenya\/Turkana County (M&B).<\/p>\n

In Tanzania, where circumcision as a cultural practice is widespread, A&N\u2019s figures show a proportion of older men presenting for VMMC through to 2013 of c.6%<\/strong>.\u00a0 Very few of these were reached through campaigns, as opposed to routine services. \u00a0In Zimbabwe, by contrast, where circumcision is not widely practised, the proportion of aged 25+ circumcised through the program was c.33%<\/strong>.\u00a0 There was much less difference in the age profiles of those accessed by campaign and routine service modalities. \u00a0Whereas, in Tanzania there is a cultural perception \u201cthat male circumcision is most appropriate before or during puberty\u201d (and older men do not come to VMMC services in a setting that includes mostly adolescent clients) – in Zimbabwe there is less difference between age groups, either in respect to numbers circumcised or preferred mode of access.\u00a0 Intriguingly, this suggests that the existence of a cultural norm of circumcision may be more of an obstacle than an asset where older clients are concerned.\u00a0 Of course, this contrast has to be set in the context of the overall advantage in terms of HIV\/AIDS prevention conferred on countries like Tanzania by the existence of the cultural norm.\u00a0 On difficulties of demand in Zimbabwe specifically, see STI\/Kaufman & Ross<\/a>.<\/p>\n

A further insight into the potentially negative impact of existing cultural practice is cast by M&B.\u00a0 Focus group discussions and in-depth interviews in the rural, traditionally non-circumcising area of Turkana County, Kenya, draw attention to perceptions of circumcision amongst older men that are not favourable to their widespread up-take, especially by the older age-group.\u00a0 The first is the identification of circumcision with the cultural values of other (potentially hostile) groups.\u00a0 Interestingly, the negative impact of the perception of the practice as imposed from outside, or else non-traditional, has been demonstrated in other non-circumcising cultures (STI\/David<\/a>; STI\/Madhivanan & Klausner<\/a>). The second is the understandable perception that HIV\/AIDS is a \u201cnew\u201d problem among young urban dwellers (most Turkana sufferers belong in this category) and that circumcision, as a response to this \u201cnew\u201d problem, is appropriate for the young, not for older, rural people (see also responses in a study on the acceptability of VMMC in Rwanda: STI\/Mbabazi<\/a>).<\/p>\n

The impression that emerges from both studies is that the existence of a cultural practice of circumcision amongst certain groups in a region does not always confer an advantage where potential clients for VMMC are in the older age groups (25+).\u00a0 In particular, good uptake of VMMC services by adolescents may actually prove an obstacle for older men, reinforcing the cultural perception of VMMC as primarily for younger men.\u00a0 In this situation service providers may face a choice between strategies that yield the greatest number of circumcisions through an exclusive focus on the younger age-group, and strategies designed to attract a wider diversity of age-groups.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

My previous blog spoke of the recent PLoS-Medicine Collection on the progress of a UNAIDS initiative for a five-year scale-up of Voluntary Male Medical Circumcision (VMMC) for HIV prevention in 14 high priority Eastern and Southern African countries.\u00a0 Among the papers, Ashengo & Njeuhmeli (A&N) and Macintyre & Bertrand (M&B) deal with what the authors […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2611,2785,2800,1694],"tags":[],"class_list":["post-1001","post","type-post","status-publish","format-standard","hentry","category-circumcision","category-implementation-research","category-programme-science","category-sti-prevention-and-surveillance"],"yoast_head":"\nCultural constraints on the uptake of voluntary medical male circumcision in Eastern and Southern Africa - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/06\/23\/cultural-constraints-on-the-uptake-of-voluntary-medical-male-circumcision-in-eastern-and-southern-africa\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cultural constraints on the uptake of voluntary medical male circumcision in Eastern and Southern Africa - 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