1. Sexual Pleasure, Reduced STI’s,
and Peer Norms:
Underlying motivations for seeking voluntary medical male
circumcision (VMMC) in Gauteng, South Africa
Authors & affiliations:
Nieuwoudt,S.1
; Frade,S.2
; Taljaard,D.2
; Spyrelis,A.2
; Rech,D.2
1.
Division of Social and Behaviour Change Communication,School of Public Health,Faculty of Health Sciences,University of the Witwatersrand
2.
Centre for HIV and AIDS Prevention Studies (CHAPS)
Results:
Despite high awareness of HIV prevention
messages, most circumcised males cited other
reasons for seeking VMMC.
Sexual Pleasure
Most participants, including uncircumcised males, believed
that circumcised males experience more sexual pleasure and
can go“more rounds”:
“I can say sex is great.…It is because of the circumcision,
because now I get a good feeling that I never did before.Like,I
was being robbed.It was being withheld and now it can come
out...Even the rounds are now longer…”
(Uncircumcised, Orange Farm, <25)
Reduced STIs
Post-circumcision there remained a prevailing attitude of
“mistakes”happen while drunk, such as unprotected sex.
However, many circumcised males felt that the consequences
had changed now that they were at lower risk of contracting
STIs:
“I remember one time I was with a girl whom most of the
guys slept with caught “drop”.So,when the guys see me with
her they told me I’d experience the same.But because I’m
circumcised,nothing happened to me.I slept with her but even
today I’m still okay.”
(Circumcised, Orange Farm, <25)
Hygiene
Participants also noted the hygiene benefits of circumcision.
The desire to remove“germs”and“dirt”was a clear reason
for seeking circumcision. It seems, however, that“dirt”and
“germs”were being used euphemistically for STI’s or HIV, as
illustrated in the quote below:
“Getting circumcised was a good way of reducing chances of
infections and disease since a foreskin also traps dirt during
unsafe sex.”
(Circumcised, OF, <25)
Peer Pressure
Circumcised males seemed proud of their efforts to shift
norms. They talked about the pressure they put on their
uncircumcised peers. Peer pressure from circumcised males
usually framed uncircumcised males as smelly, disease prone
and less sexually prow in efforts to influence them to seek
VMMC.
“We intimidate [uncircumcised peers],persuading them in a
way.We tell them “Hey,you are not a man if you still have a
foreskin…”
(Circumcised, Zola, <25)
“We do get a pressure because the guys like to tease one
another and they brag about being men because they have
their foreskins removed.That sometimes makes us feel bad and
inferior…”
(Uncircumcised, Zola, <25)
It was notable that circumcised males were much more
likely to talk about telling uncircumcised peers about
female preference for sex with them more than the HIV
risk reduction benefits.Contact: Sara Nieuwoudt
Division of Social and Behaviour Change
Communication, School of Public Health,
Faculty of Health Sciences, University of the
Witwatersrand
email: sara.nieuwoudt@wits.ac.za
Introduction:
It is widely accepted that VMMC plays an essential role in comprehensive HIV
prevention strategies in countries with generalised epidemics. An essential
part of reaching the allocated VMMC targets is to generate a strong demand
for this once-off service.
However, whether HIV prevention messages are motivating males to seek
VMMC has not been well explored. The perspectives of those who have
undergone VMMC as well as those not electing to undergo circumcision are
critical to gain insight into the decision-making process.
Objectives:
The purpose of this study was to explore the VMMC decision-making process
in the context of existing demand creation efforts in two communities, namely
Soweto and Orange Farm in South Africa.
Methods:
A qualitative exploratory study was conducted, consisting of 12 focus
group discussions with both circumcised and non-circumcised males living
in Orange Farm and Soweto. In addition, six in-depth interviews were
conducted with female sexual partners of circumcised males. A total of 70
circumcised and 54 uncircumcised males and 6 females were included in the
sample.
Data were analyzed using both deductive and inductive codes in NVivo 9,
developed and categorized by theme, using a grounded theory approach.
Conclusions:
HIV prevention was not the main (stated) reason that male participants decided
to circumcise. While they were aware of the HIV prevention benefits, other factors
appear to have had more influence over their final decision to circumcise.
STI prevention, sexual pleasure, hygiene, and peer influence, were more likely to be
cited as motivation for VMMC than HIV, and need to be accounted for in developing
more nuanced demand creation messaging. This is critical both to the achievement
of national targets as well as ensuring well-informed VMMC decisions.
Presented at the 7th IAS Conference on HIV Pathogenesis,
Treatment Prevention
Photograph 1. Young men waiting for VMMC service
outside a clinic
Photograph 2. Zola clinic,located in Soweto,a
VMMC site