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Circumcision in Zambia. Circumcision in Zambia. Traditional MC –NW Province and small Muslim communities in E. Province & elsewhere NW Province (along with N. Province) has lowest HIV rates – but syphilis rate close to national average. SBS 2000 - % Circumcised. Urban 15.3% Rural 17.8%

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circumcision in zambia2
Circumcision in Zambia
  • Traditional MC –NW Province and small Muslim communities in E. Province & elsewhere
  • NW Province (along with N. Province) has lowest HIV rates – but syphilis rate close to national average
sbs 2000 circumcised
SBS 2000 - % Circumcised
  • Urban 15.3%
  • Rural 17.8%
  • Total 16.9%
preliminary qualitative work
Preliminary Qualitative Work
  • 4 focus-group interviews with men
  • 2x2:
    • rural vs. urban
    • 18-24 unmarried vs. 25-39 married
  • conducted in Lusaka and Chongwe
  • Key informant interview with MC provider from Lusaka
groups traditionally doing mc
Groups Traditionally doing MC
  • Not having MC is associated with uncleanliness, premature ejaculation and unfitness for marriage
  • Rationale: mark of attaining manhood, protection from ‘diseases’, capacity to please women sexually
groups not doing mc
Groups Not Doing MC
  • Traditional practice seen as done without the boy’s consent
  • Seen as reducing risk of STI (incl. HIV)
  • Limited demand for MC – some informants report wishing they’d been circumcised
  • Common belief that women prefer circumcised men
age at circumcision
Age at Circumcision
  • Reported as usually between 8-15
  • Concern that if done later in adulthood, healing is slower & complications more likely
  • Mixed views on infant MC (safety concerns)
setting
Setting
  • Mixed views on traditional vs. medical
  • Tendency for those from MC-practicing groups to prefer camps; non-MC - hospital
  • Issues: safety, access, expense, associated teaching
sti hiv protection
STI/HIV Protection
  • Widely held view, even among non-MC ethnic groups, that MC reduces risk of STI/HIV transmission
  • Protection is attributed to harder, drier glans
  • A few informants consider MC as a ‘natural condom’ conferring 100% protection: most consider protection only partial
  • Some consider MC less effective in preventing HIV than other STIs
effects on sex
Effects on Sex
  • Seen to improve satisfaction for women
  • Male sexual satisfaction not seen to be threatened by MC; could be enhanced
  • View expressed that MC makes condom-use easier
concerns
Concerns
  • Fear of disease transmission with traditional practice, using the same knife on several boys (STIs, HIV)
  • Slow healing
  • Localized infection, blood loss
  • Risk of dying
  • Belief that MC is protective can encourage risky behavior
supply
Supply
  • Expense is perceived as a barrier – both for traditional MC camps and medical MC
  • Few clinicians providing MC services
  • Informants reported trying unsuccessfully to access medical MC
urban vs rural single vs married
Urban vs. Rural; Single vs. Married
  • Urban sample – less confident in safety of traditional MC
  • Little difference b/w singles and married – except married had more experience
key informant interview
Key Informant Interview
  • Lusaka-based MD from MC-practicing ethnic group
  • Reports widely held view on protection from infection
  • Reports considerable demand for medical MC, but mainly from MC-practicing groups and families having intermarried with MC-practicing groups
  • Sees slow increase in demand from other groups
  • Reports interest among medical colleagues in offering MC service
conclusions
Conclusions
  • MC is relatively uncommon
  • Interest in MC even among ethnic groups not traditionally practicing MC
  • Widely held perception that MC reduces STI (and HIV) risk, although most consider HIV protection only partial
  • Demand for more information on MC
next steps
Next Steps
  • Government interest in a pilot as groundwork to expand access to quality MC
  • Implementing partners on the ground ready to participate (JHPIEGO, Horizons)
  • Need for assessment not only of feasibility but to better characterize potential demand
  • Explore policy/ regulatory issues