Women in Kenya generally have
a good understanding of the partial protection against infection with HIV
provided to men by male circumcision, investigators report in PLOS ONE. Participants also perceived
circumcised men as being more hygienic and as taking longer to ejaculate. The qualitative
study was conducted in the city of Kisumu in western Kenya and involved 30
sexually active women aged between 18 and 35 years.
“Women will likely
have a significant influence on acceptability and uptake of MC [male
circumcision] as it is scaled up in western Kenya and elsewhere in sub-Saharan
Africa,” write the authors. “Respondents were aware that MC provides men
partial protection against HIV, but the benefits that they cited most, improved
male hygiene and cleanliness, was a reason to prefer circumcised versus
uncircumcised sexual partners. Some women also believed that circumcised men
are slower than uncircumcised men to ejaculate, thus giving women greater
controlled trials conducted in sub-Saharan Africa have shown that circumcised
men are approximately 60% less likely to acquire HIV than
uncircumcised men. Circumcised men also have a reduced risk of infection with
human papillomavirus (HPV) and herpes. Circumcision is therefore being rolled
out for the purposes of HIV prevention across sub-Saharan Africa.
wanted to ascertain women’s perceptions of circumcised and uncircumcised men
and also their knowledge of the extent of protection against infection that
circumcision provides to men.
They therefore conducted
in-depth interviews with 30 women resident in Kisumu, the fourth largest city in
Kenya, and capital of Nyanza province, which has the country's highest HIV prevalence at 15%. The main ethnic group in the region is Luo. An estimated 66% of Luo men
are circumcised, having risen from 45% in 2007. Circumcision has been promoted in the region since 2006.
The women had a
mean age of 25 years. The majority (87%) were Luo and 84% were unmarried or
were not living with a sexual partner. Participants could accurately identify
modes of HIV transmission.
Over half (57%) of
the sample reported having sex with both circumcised and uncircumcised men, 23%
said they had sex with circumcised men only, and 20% with uncircumcised men
only. Most (70%) stated their most recent sexual partner was circumcised.
Most participants were
aware that male circumcision provides men with partial protection against
infection with HIV and some other STIs (sexually transmitted infections). However, this was sometimes interpreted
as meaning that circumcised men were less likely to be living with HIV.
also sometimes equated with hygiene, and a number of women expressed the belief
that circumcised men took longer to ejaculate than uncircumcised men.
None of the women
reported that they had changed their condom use behaviour because of a man’s
circumcision status. The majority of women (70%) said that only themselves, or
mostly themselves, decided on condom use.
The majority of
women said that circumcision status would not change their decision about
condom use because they were aware that circumcised men could still have HIV. None of the participants said that they would engage in higher risk
sexual activities because a man was circumcised.
Only one woman
said that circumcision status had led to a change in her sexual behaviour. She
told investigators that she would not perform oral sex on an uncircumcised
Overall, 73% of
participants knew that circumcision reduced a man’s risk of acquiring HIV.
However, the women were generally unclear about the extent of protection
offered by circumcision. Only two respondents knew that there was an approximately 60% reduction
in HIV transmission from women to men; two respondents erroneously
stated that circumcision provided total protection against HIV and STIs; three
women did not know about the reduced risk for men contracting HIV and
five had heard of such a relationship but did not believe it to be true.
(77%) of participants reported that they preferred circumcised partners. Five women reported that when they met uncircumcised men with whom they were interested in having a sexual relationship, they insisted that the men get circumcised before they have sex.
Two women preferred uncircumcised men and indeed had not had circumcised sexual partners. One reported not understanding, and the other reported not believing, the partial protection that circumcision provides against HIV. Another women – a sex worker – said she preferred circumcised men for romatic relationships but uncircumcised men as clients; she said that this was because they reached ejaculation more quickly than circumcised
interviews…suggest that there may be a cultural preference developing for
circumcised men as sexual partners,” comment the authors. This apparent
preference is “based on proven (male risk reduction for HIV and STIs) and
unproven (male hygiene, time to ejaculation, and sexual performance) attributes
of circumcision status.”
Some women thought
they influenced men to get circumcised by talking to them about circumcision. Occasionally,
the women were more informed about male circumcision and HIV risk than their
male partners. One respondent stated that women could influence men to get
afford an opportunity to engage men and women in couples counselling,” comment
the authors. “Based on our results, it will be important to provide information
that MC provides only partial protection against female to male transmission of
HIV and some STIs; that other HIV and STI prevention methods such as condoms
need to be used along with circumcision; that MC does not preclude a man from
having HIV; and that couples should develop plans for not having sex while the
man is healing.”