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Medical male circumcision campaigns face cultural challenges in southern Africa
Laura Lopez Gonzalez, 2013-07-17 07:10:00
Campaigns to circumcise tens of thousands of men in southern Africa are falling victim to lingering acceptability issues six years after the procedure was first recommended to help prevent HIV infection, according to speakers at the 2nd International Conference for the Social Sciences and Humanities in HIV in Paris last week.
The World Health Organization (WHO) and UNAIDS began recommending medical male circumcision as an HIV prevention tool in 2007, following three large-scale randomised clinical trials. Conducted in Kenya, South Africa and Uganda, these trials found that medical male circumcision reduced a man’s risk of contracting HIV by about 60%. Following international recommendations, high HIV-prevalence countries in both east and southern Africa announced plans for large-scale circumcision campaigns.
Now researchers say campaigns in Swaziland, Botswana and Malawi are failing due to concerns from men, communities and countries about whether medical male circumcision is appropriate for them.
Programmes have paid insufficient attention to the social meaning of circumcision in different settings
Social scientists at the Paris meeting argued that those implementing medical male circumcision had paid insufficient attention to the social meaning of circumcision in different settings (it is often a marker of ethnic or religious difference, or associated with a particular form of masculinity). While there is evidence that the intervention has efficacy (in ideal conditions), it will only be effective (in real-world settings) in certain circumstances, when contextual factors including social networks, political debates and cultural values are favourable.
Biomedical researchers had “divorced any sort of understanding of the efficacy of these tools from how they operate in real people’s lives”, said Richard Parker of Columbia University. “That’s what’s missing from the evidence,” he said, arguing for more social science research to shed light on the issue.
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