Being a man, being circumcised, in northern Kenya

Attitudes, perceptions and potential uptake of male circumcision among older men in Turkana County, Kenya using qualitative methods.

Macintyre K, Andrinopoulos K, Moses N, Bornstein M, Ochieng A, Peacock E, Bertrand J. PLoS One. 2014 May 6;9(5):e83998. doi: 10.1371/journal.pone.0083998. eCollection 2014.

Background: In many communities, older men (i.e., over 25 years of age) have not come forward for Voluntary Medical Male Circumcision (VMMC) services. Reasons for low demand among this group of men are not well understood, and may vary across geographic and cultural contexts. This paper examines the facilitators and barriers to VMMC demand in Turkana County, Kenya, with a focus on older men. This is one of the regions targeted by the VMMC program in Kenya because the Turkana ethnic group does not traditionally circumcise, and the rates of HIV and STD transmission are high.

Methods and findings: Twenty focus group discussions and 69 in-depth interviews were conducted with circumcised and uncircumcised men and their partners to elicit their attitudes and perceptions toward male circumcision. The interviews were conducted in urban, peri-urban, and rural communities across Turkana. Our results show that barriers to circumcision include stigma associated with VMMC, the perception of low risk for HIV for older men and their "protection by marriage," cultural norms, and a lack of health infrastructure. Facilitators include stigma against not being circumcised (since circumcision is associated with modernity), protection against disease including HIV, and cleanliness. It was also noted that older men should adopt the practice to serve as role models to younger men.

Conclusions: Both men and women were generally supportive of VMMC, but overcoming barriers with appropriate communication messages and high quality services will be challenging. The justification of circumcision being a biomedical procedure for protection against HIV will be the most important message for any communication strategy.

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Editor’s notes:  Queues of young men and boys awaiting medical male circumcision have become a common sight at health centres, during circumcision campaigns in many parts of Africa. The authors of this paper examine why older men, defined as men over 25 years, among the Turkana of northern Kenya, have been reluctant to be circumcised. They highlight the very important role of culture – the Turkana do not have a tradition of circumcision. Neighbouring groups do circumcise, so not being circumcised is a part of being different, of embracing Turkana male identity. In addition, not being circumcised was associated with faithfulness in marriage. If a man is married then there should be no need for protection from infection, since he should not be having sex outside his marriage. However, as other studies have found, concerns about the spread of HIV as well as a desire to be seen as clean and as a role model for younger men, were facilitators of circumcision. As the authors note, appropriate communication messages are important to promote circumcision among older men. But so is an awareness of, and sensitivity to, cultural and masculine identity.

Africa
Kenya
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