A.4.Feasibility of male circumcision to improve genital hygiene and reduce HIV transmission in ten health facilities
by Rebecca Ngalande, Robert Bailey, Judith Levy, Chrissie Kaponda, Carol Chitsulo, Lucky Mhango, Eliya Chizimba, Lexa Kawala
Purpose: To explore feasibility of introducing medical male circumcision (MC) as an intervention to improve male genital hygiene and to reduce HIV transmission in selected districts in Malawi.
Methods: Separate interviews with male and female clinicians were conducted in ten health facilities from four districts using a semi-structured interview guide. The results were analysed using SPSS version 12.0 for windows (Statistical Package for Social science, SPSS Inc., Chicago).
Results: All participants 15(100.0%) explained that male circumcision (MC) is neither a common procedure during pre-service training nor common procedure in health facilities in Malawi. 2(13.2%) respondents have conducted male circumcision during their clinical practice without training. Nine (60.1%) said that MC is performed as treatment for medical problems, and 6(39.9%) for religious practices. The major disadvantage was related to cosmetic 5(33.3%), 2(13.3%) mentioned fear of death/ operation, while, 2(13.3%) were concern with safety of the procedure. Twelve (80.0%) clinicians had knowledge of association between MC, STI, and HIV, and 8(53.4%) were able to mention benefits from MC that included reduced STI and HIV. Common complication mentioned was bleeding 9(60.0%) related to lack of provider’s knowledge and skill in performing the procedure. Twelve (80.0%) showed willingness to perform MC as part of their job with no extra incentives if the service was conducted during the normal working hours. While all clinicians 15(100.0%) were willing to perform male circumcision if they were trained The barrier for introducing medical MC was lack of resources mentioned by 5 (33.3%) clinicians. Three (20.0%) stated that the current health policy does not have MC as a routine surgical procedure.
Conclusions / Implications: Male circumcision in Malawi is believed to be associated with Islam, and reduced STI infections including HIV. Introduction of male circumcision would depend adequate knowledge of benefits and risks to both communities and clinicians, and training of clinicians. Support from the Ministry of health and government would be the key motivators for clinicians to perform MC services in facilities.