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A1.Knowledge, Beliefs, and Attitudes about male circumcision to improve genital hygiene and reduce HIV infection in four districts of Malawi

Rebecca Ngalande,  Robert Bailey, Judith Levy, Chrissie Kaponda ,Carol Chitsulo ,Lucky Mhango, Eliya Chizimba ,Lexa Kawala

Purpose: To explore acceptability of introducing medical male circumcision as an intervention to improve male genital hygiene and to reduce HIV infection in selected districts in Malawi.

Methods: Separate focus group discussions with men and women aged 18 - 70 were conducted in eight communities from four districts using semi-structured interview guide. The results were analyzed  using ATLASti version 4.1.

Results:  All participants associated MC with Islam, medical problems and better genital hygiene. The common trend among all groups was the belief that MC prevents, assist in early diagnosis, treatment and healing of genital conditions. Commercial sex workers had more knowledge of the association between MC, STI and HIV than the rest of participants. Young men, young women were more knowledgeable of the association between MC and STI and only a few associated MC with HIV. Adult men from the central and northern regions were least knowledgeable of possible relationship of MC, STI and HIV among all groups.  The barrier for introducing medical MC was safety due to possibility of contracting HIV during the procedure.  Other barriers were lack of confidentiality, fear of expulsion from church, exclusion of initiation, and cost. More women than men were willing to take their sons to be circumcised compared to men.  Except for the north all women preferred circumcised males as sexual partners.  

Conclusions / Implications: Male circumcision is believed to be associated with Islam, increase genital hygiene, and reduce STD infections including HIV. Introduction of male circumcision in Malawi would depend on the safety of the procedure, increased knowledge of benefits and risks, and assurance of confidentiality. Women are likely to be key motivators for sons and young men to seek MC services.

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