impact of male circumcision in chitungwiza

8/13/2019 impact of male circumcision in chitungwiza

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CHAPTER I: INTRODUCTION

1.1 Introduction

One of the possible answers to the global pandemic of HIV is male circumcision. Malecircumcision is the removal of the foreskin. It is one of the oldest and commonest

surgical procedures worldwide (Weiss, uigle! " Ha!es, #$$$, p. #%&', undertaken for

man! reasons including religious, cultural, social and medical ()rain, Halperin, Hughes,

*lausner " +aile!, #$$&, p.'#. In adult men, a four to si- weeks period is reuired to

full! heal the wound. Healing is usuall! complete after a week when circumcision is

performed in babies (/lank " Makhema, #$$0. 1emoving the foreskin is associated with

a number of health benefits that include better penile h!giene, prevention of balanitis and

prosthitis, lower risk of se-uall! transmitted diseases especiall! ulcerative diseases such

as chancroid and s!philis, reduced risk of penile cancer and reduced risk of cervical

cancer in female partners of circumcised men ()rain et al, #$$&.

Male circumcision reduces the risk of HIV transmission b! 2$3&$4 (WHO, #$''.

Higher levels of se-uall! transmitted infections, including HIV seen in uncircumcised

men is that the inner mucosal surface of the foreskin is onl! thinl! keratini5ed and

therefore susceptible to minor trauma and abrasions that facilitate entr! of pathogens

(Hussain " 6ehner, '007, p. 273282. 9he area under the foreskin is moist and warm,

providing a microenvironment that facilitates the multiplication of pathogens, especiall!

when penile h!giene is poor (Hussain " 6ehner, '007, p. 273282. :urther, the

increased risk of HIV infection in uncircumcised men is believed to be due to increased

risk of genital ulcer diseases as well as the superficial location of HIV ; ' target cells

(


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can occur. 9he surger! can lead to e-cessive bleeding, hematoma and other

complications in initial months after the procedure. In addition adverse reactions to the

anesthetic used during the circumcision ma! occur. 9hus trained personnel and correct

euipment and aseptic conditions are necessar! for proper circumcision (1ain39al>aard,

6agarde, 9al>aard,


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is &$ percenteffective in reducing HIV incidence. 9he trials were done at Orange :arm in

Bouth ?frica (semi3urban 1akai, @ganda (rural and *isumu, *en!a (urban. (?uvert,

9al>aard, 6agarde, Bobngwi39ambekou et al, #$$7F +aile!, Moses, /arker, ?got et al.,

#$$F Gra!, *igo5i, Berwadda, Makumbi et al, #$$ 9he removal of the foreskin

reduces ones susceptibilit! to HIV acuisition.


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have been erected. Mobile clinic and clinic in bo- have been purchasedF adeuate

supplies have been purchased. However, despite all these inputs the number of men

circumcised is lagging behind set targets.

In areas where circumcision is common, HIV prevalence tends to be lower, and

conversel! areas of higher HIV prevalence overlapped with region where M< is not

commonl! practiced (AI?)DAH #$$&.


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1.* #&eci%ic o'+ecti,e

9o assess the level of knowledge of both male and female in Beke district, ward % on

male circumcision as a strateg! of preventing HIV acuisition in males.

9o establish the acceptabilit! of male circumcision b! residence of ward %, Beke

)istrict

1.- Reearch uetion

How much knowledge do people have on circumcision as an HIV preventative

strateg!

What level of acceptance do people in Beke district ward % have on male circumcision

1./ #igni%icance o% tud!

?t a global level, the research contributes towards the achievement of Millennium

)evelopment Goal number si-, which seeks to combat HIV and ?I)B, malaria and other

epidemic diseases. Male circumcision reduces the chances of acuiring HIV through

vaginal se-ual intercourse. +esides this, it has other advantages, such as being h!gienic

and reducing the chances of cervical cancer in women with circumcised partners. It

appears there isnEt enough information about the knowledge, perceptions and

acceptabilit! of male circumcision b! residents of ward %, of Beke district and even other

groups of people in the countr! for the strateg! to give desirable results of eliminating

high levels of HIV prevalence rate. 9his stud! seeks to enrich the bank of information on

the sub>ect in the countr!. ?part from this, the results would also be useful to planning

agents, both governmental and non3governmental organi5ations since HIV and ?I)B has

become a developmental issue. Beke 1ural Home +ased


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9he researcher decided to carr! out the stud! in Beke district in ward % because the area

is semi3urban all rural and urban practices e-ists and therefore the stud! will be of use in

both set3ups and the research results would be representative of both set3ups also the area

is made up of diverse traditionsD cultures and practices at one place making a good

representation of the cultures that are practiced in the countr!. Information about peopleEs

understanding in the countr! could be obtained from ward % residents. +ased on the

above considerations the researcher thought it >ustified to conduct the stud! in ward %

where residents became participants.

Male circumcision is not onl! of obvious interest to polic! makers in view of the scale of

human, social and financial resources involved. It has also aroused considerable public

curiosit!, enthusiasm and concern as a result of the sheer si5e of the programmes to

promote male circumcision. 9he results from this stud! might also have a wider

application be!ond the immediate stud! area.

1.0 De(i$itation

9he stud! sample in this research was in Mashonaland ast province in Beke district

confined to *unaka and Marikopo villages in ward three. Males and females between the

age groups '7320 were the target population. 9he stud! focused mainl! on knowledge

and acceptabilit! of male circumcision as an HIV prevention strateg!. ? clinical

procedure of doing the male circumcision surger! was be!ond the scope of this research.

1. Organiation o% the tud!

9he organisation of the stud! is the structure of the research pro>ect. It outlines the steps

that are going to be taken b! the researcher in the stud!. 9he structure of the stud! will be

divided into five chapters as followsJ

ectives of the researchF research uestionsF

significance of stud! and delimitations of the stud!.

&


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Barrier to 4CJ


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Pre,a(ence rate: 9he total number of cases of a diseases e-isting in a population

divided b! the total population. Bo if a measurement of HIV

positive is taken in a population of 2$ $$$ people and ' #$$ were

recentl! diagnosed to be HIV positive and % 7$$ are living with

HIV, then the prevalence of HIV is $,''8 or '',7$ per '$$ $$$.

( Westercamp, Aelli and 1. +ailel! #$$

1.11 Conc(uion

9he chapter introduced the topic then discussed the background to the stud!, statement of

the problem, aim of the research, ob>ectives of the research, research uestions,

significance of the stud!, delimitations of the stud!, organi5ation of the stud! and

conclusion

0


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CHAPTER 2:7ITERATURE RE6IE8

2.1 Introduction

In this chapter the researcher reviews literature on studies conducted b! different authors

on knowledge of the benefits of male circumcision, peopleEs perception of male

circumcision and acceptabilit! of the procedure.

2.2 The Dee&9rooted Cu(ture o% 4a(e Circu$ciion

Male circumcision is a surgical procedure during which all or part of the foreskin (the

fold of skin covering the head of the penis is removed b! making a surgical cut around

the head of the penis (


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discuss its use to punish, hurt others, and to cure ailments and made3up diseases (#$$.

9he same review also describes male circumcision from a political perspective when it

was used during Aa5i German! and the ?rmenian genocide to impose power and social

order over others (?ggleton and 9homas, #$$. )uring these times, circumcision status

was often used as a means to determine if someone would be condemned to death or

allowed to live. Males of all ages were forcibl! circumcised during the ?rmenian

genocide while torture and death were often the conseuences for those who were

uncircumcised in Aa5i German! and during the Ottoman and Moorish mpires (?ggleton

and 9homas, #$$.

In Bub3Baharan ?frica, where #8 of 27 countries e-ceed 8$4 of male circumcision

prevalence, circumcision is carried out for cultural reasons (WHO, #$$0, &3'7. It can

s!mboli5e movement into manhood, masculinit!, initiation rites, a blood sacrifice to the

ancestors of the earth, or it ma! be used as a social construct to engage in relationships

with women (/aise, '08F WHO, #$$0, &3'7.

?ccording to Winkel (#$$7, the ?merican medical establishment has promoted male

circumcision as a preventative measure for an astonishing arra! of pathologies, ranging

from masturbator! insanit!, moral la-it!, aesthetics and h!giene, to headache,

tuberculosis, rheumatism, h!drocephalus, epileps!, paral!sis, alcoholism,

nearsightedness, rectal prolapse, hernia, gout, clubfoot, urinar! tract infection, and cancer

of the penis, cancer of the cervi-, s!philis and ?I)B. On medical grounds, male

circumcision can be recommended if one has in>ur! or anomalies of the foreskin and if

one continues to suffer from infections.

?cross different populations, the preferred age for circumcision varies with ethnicit! and

religious beliefs. In Kudaic societies, the ritual is performed on the eighth da! after birth,

but for Muslims, there is no clearl! prescribed age for circumcision (1i5vi et al., '000.

:or man! tribal cultures in ?frica, M< is performed in earl! adult life as a rite of

passageN or a shift to pubert!, adulthood or marriage ()o!le, #$$7F )unsmuir " Goldon,

''


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'000F Marck, '00. :or e-ample the hosa tribe of Bouth ?frica and the Masai tribe of

*en!a value M< practice as a wa! to show their attainment of manhood ()o!le, #$$7.

In areas where circumcision is common, HIV prevalence tends to be lower, conversel!,

areas of higher HIV prevalence overlapped with region where male circumcision is not

commonl! practiced (AI?)DAH #$$&.


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that occurred under coloni5ation. :or e-ample, in


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Mac6eod, dwards " +ouchier (#$$ argue that, male circumcision reduces the risk of

HIV infection as the removal of the foreskin reduces the abilit! of HIV to penetrate the

skin of the penis. On the underside of the foreskin are located man! special

immunological cells, such as 6angerhans cells which are prime targets for HIV.

6angerhans cells have been found at high densities in the inner but not the outer mucosal

surface of the foreskin (ibid, #$$. 6angerhans cells, which generall! aid in immune

responses to invading pathogens can bind HIV at a specific receptor site and deliver it to

the l!mph nodes. 9he HIV will then proliferate throughout the bod!. 9hese make the

inner surface of the foreskin highl! susceptible to HIV infection compared with the outer

keratini5ed surface of circumcised penis.


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ig 2.2: Ph!io(og! o% circu$cied and uncircu$cied &eni

#ource:www.healthinfotranslations.org

)uring heterose-ual se-ual intercourse, HIV has three main pathwa!s of crossing over

the mucosal epithelium. 9he first pathwa! involves the trans3epithelial migration of

langerhans cells that have >ust been infected with HIV. 9he virus ma! infect the host b! a

second pathwa! in which it penetrates across the epithelium into the lamina propria.

6astl!, the virus ma! undergo transc!tosis b! the epithelial cells that it comes into

contact with (*awamura, et al, #$$7. 9his can be illustrated in figure #.% below.

I


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?nother plus of M< is that it can be carried out over a wide age range and it is a one3off

intervention conferring lifelong reduced biological risk. One of the beauties of

circumcision is that it is a one3off operation which takes '&3#$ minutes but then has a

profound effect on the rest of a manEs life (+aile! #$$&. It seems biologicall! plausible

that, as long as it occurs before HIV e-posure and after full wound healing, circumcision

would offer the same degree of protection against HIV and B9Is regardless of the age

(+aile! et al, #$$'.

.


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getting genital ulcerative diseases and causing bacterial vaginosis in women (/opulation

services international, #$'#

2.* Diad,antage o% 4a(e Circu$ciion

9he following are some of the disadvantages of male circumcision as viewed b!

Mac6eod, dwards " +ouchier (#$$F Male circumcision can be seen as a violation of

human rights, particularl! if carried out on children or adolescents. Male circumcision

does not provide complete protection against HIV as it onl! offers between 7$ and &$

percent protection. Men can develop a false perception of complete protection against

HIV and engage in risk! se-ual behavior without protection.


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9he above cannot be compared with what happens in the developing world, especiall! in

?frica where there is a high number of traditional circumcisers who conduct the

procedure in unsafe conditions. +aile! et al (#$$& found that, traditional circumcision in

*en!a resulted in a complication rate of %74.

? stud! conducted in 9urke! b! +aile! et al in #$$' found out that circumcisions done

b! traditional circumcisers accounted for 874 of all those involving complications, and

004 of those that were >udged serious, which included profuse bleeding, serious

infection, secondar! phimosis, meatal stenosis, and even penile amputation.

In order to minimi5e the risks associated with male circumcision, WHO, @A:/?,

@AIoint

statement in which the! stated that, countries or health care institutions which decide to

offer male circumcision more widel! as an additional wa! to protect against HIV

infection must ensure that, it is performed safel! b! well3trained practitioners in sanitar!

settings under conditions of informed consent, confidentialit!, risk reduction counseling

and safet!. WHO produced a technical manual, Male circumcision under local

anesthesiaN, which addresses the provision of safe male circumcision services for

newborns, adolescents and adults and gives detailed technical information on the

different surgical approaches.

2.- =no;(edge o% $edica( 'ene%it o% $a(e circu$ciion

In studies of acceptabilit! of male circumcision conducted in *en!a and @ganda b!

+aile! and colleagues (#$$7, a sample of adult women reported that, the! would prefer a

circumcised partner for reasons of cleanliness and reduced chances of infection. ight!

eight percent of the same women said that the! would prefer to have their sons

circumcised. 9his shows that the women had knowledge of the benefits of male

circumcision, thus the! consented to the procedure to be done on their children and

preferred it on their partners.

'8


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In another stud! in Cambia entitled, ?cceptabilit! of male circumcision for prevention

of HIV infection in CambiaN the participants showed a lot of interest in more information

on the benefits of male circumcision. 9he author of the stud! wroteF :ocus group

discussion participants were interested in more informationN. Aearl! all of the

participants in non3circumcising districts reported that the! would take their sons to a

health facilit! to be circumcised, if the! were educated on the advantages and

disadvantages of male circumcision (+aile! " 6ukobo, #$$. 9his shows that, the

people did not have enough knowledge about male circumcision. 9heir acceptabilit! of

the procedure depended on their knowledge of the benefits of the procedure. 9here was

need for health promotion programmes on the benefits of male circumcision.

1oger Bhapiro et al (#$$' conducted a cross3sectional surve! stud! with &$7 men and

women aged '8!ears and above in various geographic and ethnicall! representative

location throughout +otswana. 9he surve! consisted of a baseline uestionnaire followed

b! an informational session on the potential risks and benefits of male circumcision. ?

second set of uestions was administered following the informational session. Aot all the

participants in the stud! knew about the medical benefits of male circumcision. Initiall!

some stated that the! would not favor circumcision for themselves or their children.

However, some members in this cohort changed their minds after an informational

session on the benefits of male circumcision was conducted. +efore the informational

session, 2$8 (&84 responded that the! would definitel! or probabl! circumcise a male

child if circumcision was offered free of charge in a hospital settingF this number

increased to 72# (804 after the informational session. 9his shows that, some of the

stud! participants denied the procedure without full information on its medical benefits.

:ollowing an informational session about male circumcision, an even larger proportion of

participants stated that the! would definitel! or probabl! circumcise a male child, and a

greater number of women stated that the! would prefer to have a circumcised partner

(Bhapiro et al, #$$'. 9hus there is need to educate and re3educate people on the benefits

of male circumcision.

'0


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:rit5, Halperin " Woelk (#$$$, conducted a surve! in a Harare beer hall with #$$

randoml! selected men to assess the attitude regarding potential introduction of male

circumcision in Harare. ight! nine (80 men offered various health3related factors

associated with male circumcision. 9went! three mentioned that male circumcision is

considered h!gienic or smarter than un3circumcisedF while && said that it reduces the

likelihood of infections, including B9Is. Onl! & mentioned something on HIV that male

circumcision helps prevent B9IsDHIV infection, or that male circumcision can spread HIV

through the sharing of blades. 9his shows that ver! few men had knowledge of the

protective effect of male circumcision against HIV with si- men onl! mentioning

something on HIV. Aot all of the si- men had knowledge of the protective effect of male

circumcision against HIV sinceF some stated that there was a possibilit! of acuiring HIV

from the procedure if instruments are shared and not of the protective effect of the

procedure. 9his could be one reason wh! some people would not accept to be

circumcised.

)ube, Kanuar! " Bhamu (#$$& from the @niversit! of Cimbabwe Perce&tion on $a(e circu$ciion

+aile! " 6ukobo (#$$ conducted a stud! in Cambia, in which focus group discussion

were held with urban and rural men to assess male circumcision practices, opinions, and

acceptabilit! among married and unmarried men ages '8 to %0. 9he stud! sub>ect had

different perceptions of male circumcision. Aot being circumcised was associated with

uncleanness, premature e>aculation, and unfitness for marriage b! the traditional groups

practicing male circumcision. Male circumcision was viewed as a milestone for

manhood, protection from disease, and an enhancement for womenEs se-ual pleasure as

#$


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circumcised men are thought to be able to performN longer, thereb! increasing their

female partnerEs satisfaction (+aile! " 6ukobo, #$$

9he men among groups not practicing traditional male circumcision, e-pressed limited

interest in male circumcision although some said the! wished the! had been circumcised

because there was a common belief that women prefer circumcised men (+aile! "

6ukobo, #$$. 9his could be a problem that uncircumcised men could face especiall! in

circumcising communities. 9he! could end up undergoing the procedure not because the!

want to, but because the! would feel accepted b! their peers and females, thus avoid

stigmati5ation.

2.0 Acce&ta'i(it! o% $a(e circu$ciion

9he Cambia stud! found out that the ma>orit! of participants preferred the procedure to

be done b! a medicall! trained person in a health facilit! and should be free or at a

minimum cost. (+aile! " 6ukobo, #$$. 9his might suggest that people do not prefer

the traditional male circumcision procedure since the! stated that the! prefer it medicall!

done. 9he following were cited as reason not to circumciseJ cultural tradition, pain, and

safet!, as well as other barriers, such as cost and the concern that men would engage in

more se- if the! perceived themselves to be full! protected b! circumcisions (+aile! "

6ukobo, #$$. 9he stud! got the following reasons to circumcise, prevention of B9Is,

and h!giene. 9he participants had knowledge of the benefits of male circumcision

however, having the knowledge alone could not make them accept the procedure because

there were other factors, such as cost, place where the procedure would be done and the

e-pertiseDualification of the person carr!ing out the procedure that would make them

accept it.

Bcott et al (#$$% conducted a stud! in *waCulu Aatal, Bouth ?frica on acceptabilit! of

male circumcision as an HIV prevention method among a rural Culu population in which

he found out that about half the uncircumcised men surve!ed (7'4 said that, the! would

be circumcised if the procedure could be conducted safel! with little pain and at low cost.

Bi-t!3eight per cent of women said that the! would like their primar! partners to be

#'


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circumcised. 9here is some similarit! between the Cambian stud! and this Bouth ?frican

stud! in that the ma>orit! of the stud! sub>ect offered to be circumcised provided the

procedure is conducted in a health institution at low cost.

?ccording to Bhapiro et al (#$$', male circumcision was highl! acceptable in +otswana,

the! wroteF ?lthough the ma>orit! of males in +otswana are not circumcised, &84 of

participants in our stud! respond that the! would definitel! or probabl! circumcised a

male child if this service were offered for free in the hospitalN. 9he! cited the prevention

of se-uall! transmitted diseases, including HIV, for accepting male circumcision.

However, male circumcision was not acceptable to some people in the same stud! due to

various reasons. Of the 8& participants, who initiall! responded that the! would definitel!

not or probabl! not circumcise a male child, %74 listed pain, #&4 listed safet! concerns,

and ##4 listed religious or cultural reasons (Bhapiro et al #$$'. ?uvert et al (#$$7

found out that, culture was not a hindrance to male circumcision in a 1andomi5ed


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&$4 would accept male circumcision and enroll in a 1andomi5ed oen, #$$7 and had higher levels of education (Halperin et al., #$$7F

Bcott et al., #$$7. 9he reason being that, people living in urban areas and who are

educated are believed to be e-posed to circumcising tribes in schools and working areas,

thus thought to increase their acceptance of M< (Anko et al., #$$'. ?lso one of the

#%


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highest acceptabilit! levels of 8'4 in +otswana is that the participants agreed to a

procedure after information sessions were performed about the health benefits and the

risk associated with the procedure, compared to &'4 before the information sessions

(*ebaabetswe, 6ockman, Mogwe, Mandevu et al., #$$%.

In #$$0, the World Health Organi5ation estimated that %$4 of all males above the age of

'7 are circumcised globall! (WHO, #$$0, &

I


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CHARPTER ": RE#EARCH 4ETHODO7O


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"." Target &o&u(ation

?ccording to +abbie ('00, a population is an! group of individuals that have one more

characteristics in common that are of interest to the researcher. In this stud!, the target

population (#2% was appro-imatel! made up of residents of ward % Beke district in

*unaka and Marikopo village in the age groups '7320 !ears. ? resident is a permanent or

long3term dweller in Beke district ward %. Geographical spread of Beke district ward %

villages and the time frame of the stud! made it impossible to reach all residents of all the

villages in ward %. 9herefore a total of two focused groupsE discussions each constituting

'$ members each convenientl! selected from the two villages, %& uestionnaires and 2

purposivel! selected ke! informants were directl! interviewed b! the researcher. ? social

worker, village headmen, village health worker and a religious leader were involved

because the! were deemed knowledgeable about male circumcision and social issues in

their localit! affecting the uptake of male circumcision..

".) #a$&(e and #a$&(ing Procedure

?ccording to Baunders (#$$%, a sample si5e can be defined b! using at least '$3#$4 of

the targeted population. Aon3probabilit! convenience sampling method was used to

select two villages in ward % Beke district namel! Marikopo village and *unaka village

9he researcher live in Marikopo village and *unaka village is ver! close to the

researchersE homestead. 9he s!stematic sampling techniue was used to come up with a

sample population. In this case '74 (%& of the permanent residents (#2% was used due

to financial and resource shortage. Aon3probabilit! convenience sampling method was

used to select %& residents into the stud!. 9he researcher convenientl! selected residents

that were at home on the da!s of data collection. 9hose who were not at home due to

various reasons did not have the chance to participate in the stud!. 9he researcher could

have used probabilit! sampling but due to limitation of time, he was not able to do so.

/robabilit! sampling reuired a lot of time to come up with a complete sampling frame in

the stud! sites and then sample from it. On the other hand, non3probabilit! sampling is

#&


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limited in that all the residents were not given eual chance to be selected into the stud!

thus there was some selection bias.

:or the focused group discussions non3probabilit! convenience sampling was also used

to select 7 males 7 femalesE participants in each village from different interest groups

from the %& target population sample. )owd! #$$$ views that :G)s must not e-ceed '#

people for people to clearl! share their views and avoid it to act like a public meeting.

9he sampling method for interviews was purposive sampling. 9hose who had detailed

information on health and social issues were selectedF these included the village health

worker, a traditional healer, a religious leader and a village headman.

Ta'(e ".1Co$&oition o% the reearch a$&(e

Instrument Targeted population Atual

!opulation

"sample size

#omposition

uestionnaire #2% %& 1esidence male or female '73

20 !ears oldInterview

guide

'# 2 Bocial worker, 9raditional

leaders, village health workers,

1eligious leaders:G)s %& #$ /6H?,


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the phasing of if a woman would prefer a circumcised partner. In order to get more

information to the impact of motivation the uestionnaire had to be reconfigured to

accommodate more open ended narratives. ?fter the necessar! changes have been

effected, the uestionnaires were sent out into the field for a period of # da!s.

".- Data co((ection &rocedure

9he data collection procedure included self3introduction of the researcher to the

respondents followed b! assurance that the research was for academic purposes before

conducting an interview, focused group discussions or issuing out a uestionnaire.

?t each stud! village, the researcher moved on foot and distributed the uestionnaires to

the selected individuals. He made the respondents to sit as far awa! from each other as

possible so as to discourage an! undue influence among the participants during the

answering session. +efore the interviews and focused groups discussions the researcher

first e-plained to the participants about the stud!, its purpose and ob>ectives and how

the! would contribute to the stud!. 9he participants were given the opportunit! to ask

uestions about the stud! and other issues of interest to them. 9he researcher answered

all their uestions and then asked for their consent to participate in the stud!. 9he

researcher was taking down notes during interviews and focused groups discussions

"./ Reearch 4ethod

1esearch methods are tools used to gather data, such as uestionnaires and interviews

()awson, #$$0. 9hree methods were used and these are the :ocus Group )iscussions

guideline, interview guide and uestionnaires as discussed below.

uetionnaire

9he researcher used self3administered uestionnaires to collect information from stud!

participants. ?ccording to 6eed! " Ormand (#$$7, a uestionnaire is an instrument with

open or closed uestions or statements, to which a respondent must react. 9his was a

primar! source of data collection. 9he researcher designed two self3 administered

uestionnaires, one for males and the other for females. ach uestionnaire was

accompanied b! a covering letter e-plaining the purpose of the stud! to the prospective

#8


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respondent. General instructions on completing the uestionnaire and the importance of

completing all uestions were included. 9he covering letter e-plained wh! it was

important that the potential respondent personall! completed the uestionnaire.

?part from establishing rapport, it was also aimed at gathering as much information as

possible from them on their demographic characteristics, their knowledge and

perceptions of male circumcision and their acceptabilit! of the strateg!. 9he! were asked

to state how the! would want circumcision to be performed and whether the! think itEs

necessar! to embark on a massive campaign of male circumcision. :emales were asked if

it matters to them to have a circumcised partner or not. +oth females and males were

asked whether circumcision was of an! importance to them and whether the! would

accept to circumcise their male children. 9his techniue was chosen as it could be

completed at the respondents convenient. 9he researcher encountered >ust a few problems

using this techniue. 9he first was it was time consuming as it took two da!s to drop and

collect the uestionnaires. ?t times, the residents were not available when the researcher

visited the houses to collect the uestionnaires. Becondl! respondents did not seem to

appreciate the value of the research as the! did not answer some of the uestions. 6astl!

the responses can be biased, for e-ample respondents can lie about their circumcision

status.

Inter,ie; guide

9he interview techniue is a direct method of obtaining information in a face3to3face

situation which is a critical aspect of ualitative data collection ()awson, #$$0. 9he

researcher interviewed. 9he researcher wanted to find out peopleEs knowledge and

acceptance of M< as an HIV prevention procedure from ke! informantsF these included a

village health worker, pastor, traditional healer and a village headman. 9he same

uestions on the uestionnaires were used on interview. 9he researcher followed thebasic rules in an interview which are courtes!, tactful and acceptance, non3>udgmental

and confidentialit!. 9he researcher was formall! dressed.

9he researcherJ Initiated the interview, put the respondent at eas!. 9he researcher had the

skill of creating a rela-ed and natural atmosphere, was business3like and not long and

#0


30/76

winding, and kept the interview situation as private as possible, avoid stereot!ping, was

thorough and familiar with the surve! instrument, asked the uestions in a proper

seuence, did not assume to an! uestion, spoke slowl! so as to be clearl! understood,

did not put answers in the respondentEs mouth, probed when need arise and recorded

responses.

9he merits of an interview included the fact that the response rate was high. 9here was

completeness as all uestions were answered. 9here was room to probe comple- and

emotionall! charged issues. 9he interviewer e-hibited fle-ibilit! as he repeated uestions

or probe henceF there was ma-imi5ation of trust between the interviewer and the

interviewees. Bome of the demerits of interviews were that interviews are length!. 9he

mood of the respondents affected responses. Bome respondents felt uneas! and adopted

avoidance tactics, when uestions were too personal and there was no opportunit! to

make research b! consulting records.

ocu


31/76

uncomfortable in group setting and nervous about speaking in front of others, but the

researcher encourages them to speak freel! because the discussed issues were to remain

confidential.

".0 Data #ource

Mainl! primar! data was collected from interviews, uestionnaires and focus group

discussions which were guided b! respective research tools in the field. Becondar! data

was onl! used where the interviewees referred to their written documents relative to the

research uestions asked.

". Data Ana(!i Procedure

uantitative data from uestionnaires was anal!5ed using B/BB and ualitative data was

anal!5ed thematicall!. 9he following steps were taken to anal!5e ualitative data from

interviews and :G)sJ transcripts were coded using the participantsE own words and

phrases and without pre3conceived classificationF the participantsE language or phrases

were e-amined, categori5ed and recurrent themes were identified. 1ecurrent themes are

the similar and consistent wa!s people think about, and give accounts concerning

particular issues. -amples of repetition, e-planation, >ustification and vernacular terms

were highlighted. 9hese were then coded with a ke! word or phrase that captured the

essence of the content, and were taken to constitute emergent themes.

)ata from uestionnaires was anal!5ed using the Btatistical /ackage for Bocial Bciences

(B/BB and responses were coded using numbers according to the respondentsE answers.

:or e-ample, a LBN was coded as ' and a AON coded as #. :or open3ended uestions

all ideas were listed first, and then tallied to indicate how the respondents gave the same

response. ?ll data from uestionnaires was coded in B/BB for all the uestions before the

data was edited and then presented as tables, charts and graphs using Microsoft -cel.


32/76

".13 4a& and Decri&tion o% the #tud! Area

ig ". *: #eke ditrict $a&

#ource: 'e(e )ural Home *ased #are, 20+0

4a& o% the tudied area

ig ". -: 4a& o% #eke co$$una( area@ ;ard "

? boundar! in fig %.& below within Beke communal area indicate the area the researcher

did his research, that is Marikopo and *unaka village

%#


33/76

#ource:!rimar% data

".11 Decri&tion o% the #tud! Area

Beke district is in Mashonaland east. In Beke district the main source of livelihoods is

farming. +ecause of its pro-imit! to the capital cit!, a notable section of the populationwork in Harare and


34/76

Marikopo and *unaka villages are dominated b! market gardeningF people sell their

agricultural produce to nearb! markets such as Makoni, Mbare and Harare. 9he nearest

hospital is *unaka hospital appro-imatel! #.7km from the distant homesteads. Beke

Home +ased or role in educating the local people about male

circumcision. Marikopo primar! and secondar! school is located within Marikopo village

".11 #u$$ar! o% cha&ter

9he methodolog! that sought to guide this research has been discussed in this chapter.

*e! areas discussed were the research design, population sample and sampling

procedures, research instruments, data collection, presentation and anal!sis procedures.

9his >ustified the research posture, in terms of validit! and reliabilit!. 9he ne-t chapter

presents, anal!ses, interprets and discusses the data.

%2


35/76

CHAPTER ): DATA PRE#ENTATION ANA7?#I# INTERPRETATION AND

DI#CU##ION

).1 Introduction

In this chapter, the researcher interprets, anal!5e, present and discuss the results obtained

from the two villages in ward % Beke district. 9he results are categori5ed into five main

sections namel! demographic characteristics of respondents, knowledge of benefits of

male circumcision, perceptions of respondents on male circumcision, acceptabilit! of the

procedure and suggestions on how male circumcision can be promoted to become one of

the HIV prevention methods.

).1.1 Re&one Rate

9he response rate was high because of the follow3ups on the part of the researcher and

support from the respondents

Ta'(e ).1Re&one rate(Bource$ !rimar% data

Intru$ent ued Targeted

re&ondent T

Actua(

re&ondentA

Re&one rate

AT133F

uestionnaire guide %& %# 0F

Interview guide 2 % /*F:G) guide #$ '8 3F

Tota( -3 *" 00F

9he adoption of an action research approach on motivated volunteers ensured a strict

follow up of respondents to honor appointments for meetings. 9he high response rate of

884 gives confidence that the results are valid for the purposes of this stud!. It actuall!

surpasses that of 9erthu *utupu Agod>i, #$'$ which had which makes the research

results more valid and possibl! fill the gap that was left out. 9he reason for the '#4shortfall can be attributed to situations be!ond the researcher and the respondentsE control

such as misplacement of the papers, sicknesses and absenteeism. :rom the uestionnaires

the researcher managed to get %# respondentsF '7 (284 males and ' (7#4 females.

9his was 804 of the e-pected (calculated sample si5e. :rom interview guides the

respondents were one man (%%4 and two women (&4. 9his was 74 of the e-pected

%7


36/76

calculated sample si5e. ight (224 and ten (7&4 women participated in focused groups

discussions. 9his was 0$4 of the e-pected calculated sample. 9heir ages ranged between

'7 and 20 and their average age was #2.7 !ears. ?ll were residents in ward %, Beke

district. )etailed information about the respondents can be shown below

Ta'(e ).2: #tud! &artici&ant %or Guetionnaire &er tud! center N"2 133F

Name of villages Number of males - Number of females % Total %

*unaka 22 0 20 1- *3Marikopo 8 2* 8 2* 1- *3TOTA7 1* )/ 1/ *" "2 133

#ource:!rimar% data

Ta'(e ).": #tud! &artici&ant %or %ocued grou& dicuion &er tud! center N 10133F

Name of village Number of males % Number of females % Total %

*unaka % 1/ 2 22 / "

Marikopo 7 20 & "" 11 -1TOTA7 0 )* 13 ** 10 133

#ourceJ /rimar! data

Ta'(e ).): #tud! &artici&ant %or the inter,ie; N "

Occupation Sex Village Allocated time Time taken

Village health worker :emale Marikopo &$ minutes 2' minutesVillage headmen Male Marikopo &$ minutes ## minutes/astor :emale *unaka &$ minutes %0minutes

#ource:!rimar% data

9he tables 2.2 above show that village health worker took more time that is 2'minutes

because she knows a lot about male circumcision. 9he pastor followed with %0minutes he

know the biblical aspect a lot than the medical benefits of male circumcision. 9he village

headmen knew limited information about male circumcision. 9he researcher deduced thathaving access to information about male circumcision makes people knowledgeable and

for e-ample a village health worker knew a lot about male circumcision because of

access to information.

).2 De$ogra&hic characteritic o% the re&ondent

%&


37/76

9he ma>orit! of the respondents '0 (70.24Q were married while '% (2$.&4 were single.

ver! respondent did specif! their marital status. 9he respondents had #2 (2.'4 male

children and the rest had # (7#.04 female children.

Ta'(e ).*: #ocio9de$ogra&hic characteritic o% tud! &artici&ant

Characteristics Study sample N !" #ercentage

Age $&'"( #$.7

"'") '$ %2.'

"*'!+ 7 '.'

!&'+" 2 ''.2

+!'+, 2 ''.2

$+- # 7.

Number of children .ales #2 2.'

/emales # 7#.0

.arital status 0nmarried '% 2$.&

.arried '0 70.2

1eligion Christianity #8 8.2

African Tradition # &.%

0nspecified # &.%

#ource:!rimar% data

9went!3eight (8.24 of the respondents were


38/76

shown from fig 2.' One respondent who finished at primar! school knew nothing about

male circumcision on the other hand # respondents who were degree holders knew a lot

of information about male circumcision. Generall! ordinar! level, advanced level and

diploma holders knew basic information about male circumcision.

igure ).1: Educationa( (e,e( o% the re&ondent

#ource:!rimar% data

:rom the research findings level of education affected oneEs knowledge and perception

about male circumcision. 9his can be so because higher levels of education e-pose

people to various literatures and social contact with a broader mi- of different ethnic and

religious groups. 9his in turn increases the likelihood of access to information about male

circumcision as purported b! @rassa, 9odd, +oerma, Ha!es et al., '00.

9wo men who were circumcised one was a diploma holder and the other one doing

advanced level this showed that higher levels of education are associated with higher

rates of circumcision among non3circumcising societies. 9he findings concurs with

studies in traditionall! non3circumcised societies in 9an5ania and Bouth ?frica which

indicated that higher levels of education were associated with higher rates of

circumcision among non3circumcising societies (Halperin et al., #$$7F 1ain3 9al>aard et

al., #$$%.

)." =no;(edge o% $edica( 'ene%it o% $a(e circu$ciion

%8


39/76

9he ma>orit! of the respondents #% ('.74 stated that male circumcision was not

practiced in their cultureDtradition or their religion. 9his result concur with those of other

studies in ?frica where circumcision is not a traditional practice including +otswana

(*ebaabetswe et al., #$$%, Bouth ?frica (6agarde, #$$%F 1ain39al>aard et al., #$$%F

Bcott et al., #$$7 and *en!a (Mattson et al., #$$7. :our ('#.74 stated it was practiced

in their tradition while 7 ('&4 respondents had no idea whether it was practiced or not.

Bevent!3three percent of the respondents correctl! defined male circumcision.


40/76

No idea % (

Tota( "2 ((

#ource:!rimar% data

In contrast :rit5 et al (#$$$ found out that, & (&.4 of the 80 men who knew about the

benefits of male circumcision mentioned something on HIV and h!giene in their stud!.

9he percentage of respondents with information in this current stud! was higher than in

:rit5 et al (#$$' stud!. 9his could be attributed to difference in time when the studies

were conducted. Aowada!s people are having more information about HIV and male

circumcision than the! had in #$$'. 9he difference could also be attributed to the

characteristics of the respondents. :rit5 et al (#$$' used males from a beer hall, while

this stud! incorporated residents of ward %, Beke district in a peri3 urban area with access

to the information.

Ta'(e )./: Aociation 'et;een =no;(edge and Re(igion n"3 133F

123454ON 6no7ledge of benefits

Had

kno;(edge

F No

kno;(edge

F TOTA7 F

?frican

9radition

' " ' " # -


41/76

#e5ua( ineniti,it! # Poi'i(it! o% getting HI6 i% intru$ent are

hared

% '$

Death ' %8ound take (ong to hea( 7 '

Da$age to the &eni 2 '2E5cei,e '(eeding 7 'Can caue eriou in%ection 8 #0TOTA7 2 133

#ource:!rimar% data

9went!3nine (0'4 of the respondents stated a variet! of complications of male

circumcision which are summari5ed in the table 2.8 above. 9en percent of the

respondents stated that one could end up contracting HIV if instruments are shared during

the procedure. 9he common complication was serious infections. However, three (04 of

the total respondents of %# had no idea of an! complication of the procedure. 9he finding

gives >ustification wh! male circumcision is not well accepted as an HIV prevention

strateg!. 9he complications correspond with those from studies carried out in Bouth

?frican (Bcott et al., #$$7 and *en!a (Mattson et al., #$$7.

Bcott et al (#$$% found out that, more than half the uncircumcised men surve! 7'4 said

that the! would be circumcised if the procedure could be conducted safel! with little pain

and at low cost. 9he respondents in this current stud! also opted for safe conditions

which were found when the procedure is medicall! conducted.

Ta'(e ).: Circu$ciion tatu ,eru Bene%it o% Circu$ciion N1* 133F

Circu$ciion

tatu

Conideration o% $a(e circu$ciion

'ene%icia( F Non9

'ene%icia(

F Tota( F

Aot circumcised 8 7% 7 %% 1" 00


42/76

9able 2.0 above shows that, there appears to be an association between being circumcised

and consideration of the procedure as beneficial to oneself. 9his ma! suggest that if men

are well informed about the benefit of male circumcision the! will probabl! get

circumcised. :rom the narratives on whether circumcision was of an! benefit to the

males, '$ (&4 stated that it was of beneficial to them and # were circumcised on the

other hand 7 (%%4 of the '7 males stated that it was not beneficial to them and no3one

was circumcised. 9he benefits include protection against B9Is and HIV and improved

h!giene. 9wo of the '7 respondents did not state an! benefits even though the! had

indicated that circumcision was beneficial to them.

ig ).2: Percentage o% $en ;ho ;ere circu$cied and uncircu$cied

#ource:!rimar% soure

:rom the fig above # ('#4 of men were circumcised and the rest ('% 884 were not.

9his showed low levels of circumcision rates amongst the male respondents. 9his stud!

concurs with the :rit5 et al.s (#$$$ stud! in terms of high rate of non3circumcision

which was 8&4. 9his also concurs with the #$$0F World Health Organi5ation which also

estimated low levels of circumcision rate of %$4 globall!.

2#


43/76

9en (&$4 of the ' women stated that, male circumcision was beneficial to them while

(2$4 stated that, it was not beneficial to them. Bome of the benefits listed b! women

included reduced chances of B9I infection including HIV, protection from cervical cancer

and improved h!giene as shown on the table below

Ta'(e ).13 Bene%it o% 4a(e Circu$ciion 4entioned '! e$a(e. N13

Bene%it reGuenc! Percentage

/rotection from cervical

cancer

# 23

/rotection from B9Is and

HIV

& -3

Improve general h!giene # 23TOTA7 13 133


When the researcher compared results from focused groupsE discussions, uestionnaires

and interviews on the benefits of M< to men and women he concluded that respondents

are knowledgeable about the benefits of male circumcision.

).) Perce&tion on 4a(e Circu$ciion

9o find out about the perception of the respondents on male circumcision all the three

data sources were used. 9o get an in3depth understanding of perceptions in the area in3

depth interviews were held with village health workers, headmen and a pastor. :rom the

research findings generall! more respondents (&$4 viewed male circumcision as good.

9went!3three percent of the participants stated that, male circumcision was bad while

'4 of the respondents did not state their perception the figure below is a summar! of

the respondentsE perceptions. 9here is a knowledge gap within the respondents that can

onl! be bridged b! health promotion strategies. Most of the males with a negative

perception of male circumcision were not circumcised. However this is not surprising as

those alread! circumcised would have an overt appreciation of the procedure.

2%


44/76

However after information sessions of the benefits of male circumcision some people

began to have positive perceptions of the procedure and four men accepted to be

circumcised. 9welve percent of the women who initiall! had a negative perception on

male circumcision changed their view to accepting that male circumcision should be

practiced. Btriking were the male respondents who did not change their negative

perception on male circumcision.

9his is comparable to what was found b! Bhapiro et al (#$$' when some respondents

changed their perception and accepted to be circumcised. ?mong #%8 uncircumcised

men, '0# (8'4 after the informational session changed their perceptions and some

voluntaril! accepted to be circumcised (Bhapiro et al, #$$'. 9his further demonstrates

the fact that, there is an association between knowledge and perceptions increasing oneEs

knowledge can possibl! influence oneEs perception in the positive or negative sense

depending on the advantages or benefits one would stand to gain

ig ).". Perce&tion on $a(e circu$ciion

#ource$ !rimar% soure

22


45/76

9able 2.'' below shows the association between knowledge of medical benefits of male

circumcision and the respondentsE perception.

Ta'(e ).11: Aociation 'et;een =no;(edge and Perce&tion on 4a(e Circu$ciion

n"2

=no;(edge o% 'ene%it Perce&tion

Aegative /ositive 9otal

)id not have the knowledge 2 # -

Had the information 8 '8 2-

9otal 12 23 "2


:rom the table above twent!3si- (8'4 respondents had the knowledge on male

circumcision and si- ('04 did not have the information. 9here was a significant

association between knowledge of respondents on benefits of male circumcision and their

perception of the procedure. 9he negative perceptions in most of the respondents could

have been a result of lack of knowledge or limited information of medical benefits of

male circumcision. 9he stud! found a significant association between the two. Having theknowledge of the benefits of male circumcision is paramount in building a positive

perception of the procedure as those who were circumcised or knew of its benefits had a

positive view of the procedure. It would be logical to have a handful of the respondents

with a negative perception of the procedure since some of them did not have enough

information on the medical benefits of male circumcision. It is difficult for people to have

a positive perception when the! are not full! informed about the benefits of the

procedure. *nowledge is power as it can influence oneEs perception

27


46/76

Ta'(e ).12: Aociation 'et;een Re(igion and Re&ondent &erce&tion n "3

RE7I


47/76

!ears and above age3group was ver! low. :igure 2.2 below shows the willingness to be

circumcised amongst the uncircumcised male respondents. 9here was a significant

association between willingness to be circumcised and consideration of the procedure as

of benefit to the respondents.

ig ).) Acce&ta'i(it! o% $a(e circu$ciion a$ongt the uncircu$cied $a(e

#ource$ !rimar% soure

:rom the fig above the ma>orit! of the uncircumcised males were not willing to becircumcised. 9his was lower than those who were willing to undergo the procedure in

:rit5 et al.s (#$$$ stud!. 9his was close to half of those who were to undergo the same

procedure in Bhapiro et al (#$$', which had acceptabilit! level of &84.

With the high level of knowledge of benefits of male circumcision, people would have

positive perception, and would opt for the procedure but this is not the case. :our (%%4

of the respondents who were willing to undergo the procedure had a positive perception

of the procedure. 9his was a good indicator b! possible of the earl! adopters of male

circumcision should the innovation be made to diffuse into the members of the stud!

area. 9hirt!3three percent of the males who were willing to be circumcised were

significant suggesting that an! promotion of this procedure should target these

respondents as peer educators. 9he males stated the following reasons for accepting to be

2


48/76

circumcisedF protection from B9Is and HIV, improved h!giene since circumcised men

were considered to be more h!gienic than uncircumcised men and se-ual pleasure

because of dela!ed e>aculation. On the other hand reasons for den!ing circumcision

included, it being too painful and torturous, possibilit! of getting HIV if contaminated

instruments were shared during the procedure, fear of damage of the penis leading to

infertilit!, it being not necessar! at all to others while others believed that circumcision

was against what God wanted men to look like at creation, so the! did not accept to be

circumcised.

9hirteen (0%4 of the fourteen parents stated that their male children were not

circumcised this implies that parents were not circumcising their male children. 9he

results concurs with )emographic and Health Burve! results of Aamibia #$$&, which

indicated that M< prevalence in children was ''4 (MOHBB, #$$8 leven (&'4 of the

'8 respondents that currentl! did not a male child stated that the! would accept to

circumcise their children, (%04 stated that the! would not circumcise their children.

While one was not sure. ?fter parents were told of the benefits of male circumcision

acceptabilit! to circumcise their male child increased from &24 to 8%4. It was difficult

to accept male circumcision when the parents were not informed and convinced of the

benefits of the procedure. 6ack of knowledge would lead to negative perception which

would ultimatel! lead to low acceptabilit!. ?s mentioned on Bhapiro et al (#$$',

acceptabilit! of the procedure increased after an informational session on the benefits of

male circumcision was offered to the stud! participants.

One of the main findings of this stud! is that most of the participants prefer M< to be

performed during the infanc! period (less than ' !ear. Bimilar results were found from

the stud! in non3circumcising communit! in +otswana (*ebaabetswe et al., #$$%.

28


49/76

Ta'(e ).1": Reaon %or Circu$ciing 4a(e Chi(dren n"2

Reaon %or circu$ciing $a(e chi(dren reGuenc! Percent

Be-ual satisfaction of future partner 1 ":ollowing culture and traditions "

H!giene 0 2*

/rotection against HIV and B9Is 23 -"

TOTA7 "2 133

'oure$ !rimar% soure

9he reasons for circumcising children included protection against B9Is and HIV,

improved general h!giene, following cultureDtradition and se-ual satisfaction of their

future female partners and the table 2.'% above summari5es the general reasons. 9hirt!3

nine percent of the respondents who had a male child were willing to circumcise their

male children. 9his is dissimilar to the research findings of +otswana Havard ?I)B

Institute /artnership #$$' (*ebaabetswe, et al, #$$% which found out that &84 of the

respondents were willing to circumcise a male child. ?lso Westercamp and +aile! found

out that '4 (7$30$4 of men and 8'4 ($30$4 of women would circumcise their sons

if given the chance. However more specific reasons against circumcision of children are

summari5ed in the 9able 2.'2 below.

Most of the parents stated that their children were not circumcised, echoing the high

rates of non3circumcision among the respondents. 9his could be due to lack of

information on the benefits of male circumcision or due to the rarit! of the procedure in

hospitals and clinics. With the fear that clinicall! performed circumcision could result in

complications and looming possibilit! of contracting HIV through sharing instruments,

man! people would not be willing to be circumcised.

20


50/76

Ta'(e ).1): Reaon againt circu$ciion o% chi(dren n"2

Reaon %or not circu$ciing a $a(e chi(d reGuenc! Percentage

6ack of knowledge of benefits of the procedure # &

It is outdated ' %?gainst what God created man like # &

Aot necessar! 2 '%

Bhould be personal choice & '0

Aot wanting to see a child suffering because of pain % 0

Aot believing in male circumcision # &

:ear of complications '# %8

Tota( "2 133


:rom the table above the highest freuenc! was fear of complications followed b!

personal choice.


51/76

the traditional conducted one for themselves for the reasons that circumcision was a

traditional practice that should be done traditionall!. 9he! also said that, the traditional

circumcisers were more e-perienced than the medical ones since the practice is done

more traditionall! than medicall!. 9hose who opted for medical circumcision stated that,

it was conducted under h!gienic conditions and the chances of getting an infection or

complications were less since there would be ualified personnel to deal with an!

challenging situation that ma! arise during and after carr!ing out the procedure.

ig ).*: PrereGuiite %or Undergoing Circu$ciion n"2


ighteen (7&4 of the %# respondents stated that, the! would consider the benefits of

undergoing procedure, '$ (%'4 considered h!gienic conditions, while 2 ('%4

considered the e-perience and ualifications of the practitioner. :rom the research

findings people consider the benefits of undergoing the procedure more than h!giene

conditions and e-perience and ualifications of the practitioners when the! want to be

circumcised.

7'


52/76

ig ).-: 8o$en &re%erence on 4an Circu$ciion tate N 1/


:ig 2.7 shows that & (%74 of the ' women stated that, the! would accept an! man

whether circumcised or uncircumcised. 9he ma>orit! of these women stated that, the! did

not have enough knowledge on the difference between these two conditions to warrant

them to make a choice between the two. 9o them a male was a male whether circumcised

or not, while 8 (2&4 stated that the! preferred circumcised men for cleanliness, less

chances of getting B9Is and se-ual satisfaction especiall! dela!ed e>aculation. On the

other hand '04 preferred uncircumcised men for the reasons that the! en>o!ed pla!ing

with the foreskin of the penis and that the uncircumcised head of the penis is se-uall!

sensitive as the! regarded the circumcised penis as insensitive. However, according to

Gra! (#$$, male circumcision does not reduce levels of se-ual desire, satisfaction or

performance.

).- #uggetion on &ro$otion o% $a(e circu$ciion

7#


53/76

9he ma>orit! of the respondents #' (&4 out of %# were of the opinion that there was a

need to embark on a nationwide programme to circumcise males, while %%4 of the

respondents were indifferent.

1espondents also came up with suggested age groups to conduct male circumcision, the

most suggested groups were at infanc! and under3fives. 9he most common suggestion

was carr!ing out awareness campaigns on the benefits of male circumcision to all the

people, parents and !outh included in a bid to create awareness to ever!one. 9his was

suggested b! 884 of the total respondents. Other suggestions included offering male

circumcision at ever! maternit! clinic and hospital free of charge and making it

compulsor! to ever! male.

)./ Conc(uion

9he researcher presented results obtained from the stud! participants. Most of the

respondents had information on the benefits of male circumcision. On perceptions, the

ma>orit! had a positive view of male circumcision however low acceptabilit! of the

procedure was noticed as the respondents are afraid of complications. 9he chapter ended

b! compiling suggestions made b! respondents on how male circumcision could be

promoted to be one of HIV prevention methods.

).0 #u$$ar!

9his chapter presented results of the research stud!. It looked at knowledge, perceptions

and attitudes of participants, on the ma>or issues surrounding the male circumcision in

Beke district. 9he findings showed that, most people knew about male circumcision and

had knowledge of the protective effect of the procedure against HIV acuisition and

transmission. However few people are willing to be circumcised. 9he ne-t chapter gives

a summar!, conclusions and recommendations of the research stud!.

CHAPTER *

7%


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#U44AR?@ CONC7U#ION# AND RECO44ENDATION#

*.1 Introduction.

9his chapter consists of three sections, which wind up this research report. 9hese are the

summar!, research conclusions and recommendations.

*.2 #u$$ar!

9he stud! set out to establish the level of knowledge and acceptabilit! of male

circumcision with the hope of using the information to develop health promotion

programmes on the strateg! in Beke district and in the countr! at large in an effort to

reduce the transmission of HIV. +esides the above, male circumcision it has other

advantages, such as being h!gienic and reducing the chances of cervical cancer in women

with circumcised partners. In addressing what appeared to be lack of enough information

about the knowledge, perceptions and acceptabilit! of male circumcision in ward %, Beke

district and even other districts in the countr! for the strateg! to produce fruits. 9his stud!

set to enrich the bank of information on the sub>ect in the countr!.

9he research findings would assist in the strategic evaluation of current HIVD?I)B

prevention strategies, so as to enable the formulation and improvement of the multi3

sectorial and multi3methodical approaches to the disease prevention. In order to

accomplish the assessment, a sample of %# residents from # villages of ward %, Beke

district were involved in the stud!. 9he methodolog! was based on the viewpoint that,

knowledge of HIVD?I)B prevention in Beke district is relative and cannot be amendable

to an! form of classification, hence there was need to come up with first3 hand

information using ualitative and uantitative techniues in a descriptive surve!. 9he

researcher used purposive sampling techniue and non3probabilit! convenience sampling

to come out with an optimal sample si5e.

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9he stud! then used uestionnaires, focused groups discussions and interviews to get

information on knowledge and acceptabilit! of male circumcision as an HIV prevention

strateg!. 9he stud! wanted to solve the problem where it appears that low level of male

circumcision countries coincidentall! have the highest burden of HIVD?I)B in the world.

Aevertheless, male circumcision has been perceived as a culturalDtraditional act that is

backward and not necessar!.

In carr!ing out this stud!, a handful of the respondents had problems in answering the

uestionnaire owing to the levels of their literac!. 9he researcher trained research

assistants to help those who were to complete the uestionnaire. )ue to limitation of time

the researcher carried out non3probabilit! convenience sampling which could have

caused biasness also the researcher could not reall! check whether those who claimed to

be circumcised were not l!ing. Most respondents managed to fill in their uestionnaires.

)espite the above constrains the following conclusions could be made.

*." Conc(uion

Most respondents knew about male circumcision at least most of them had knowledge of

the protective effect of the procedure against HIV acuisition and transmissionF some few

respondents had information of other benefits, such as cleanlinessDimproved h!giene and

reduced chances of getting other se-uall! transmitted diseases.

Bi-t! percent of the respondents had positive perception of the procedure whilst #%4 of

the respondents perceived male circumcision as bad and were of the opinion that, the

procedure was supposed to have been stopped long ago, and '4 of the respondents did

not state their perceptions. 9he stud! found out that, there was a significant association

between knowledge of medical benefits of male circumcision and oneEs perception of the

procedure. 9hus, increasing oneEs knowledge on the medical benefits of the procedure is

paramount in creating a positive perception of male circumcision.

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9welve percent of men were circumcised this showed low levels of circumcision rates

amongst the male respondents. Most of the parents stated that their children were not

circumcised, echoing the high rates of non3circumcision in the studied area. 9he

procedure was lowl! accepted b! the respondents with a percentage acceptabilit! of %%4

b! the male respondents, while %04 of all the respondents e-pressed their willingness to

circumcise their male children. ?lmost all the respondents preferred medicall! performed

circumcision. Medicall! performed circumcisions were preferred because of the e-pertise

and professionalism of the people conducting the procedure and reduction of chances of

complications.

?cceptabilit! of male circumcision was affected b! people uestioning the procedure and

peopleEs knowledge of its benefits as these aspects had a significant association with each

other. 1aising peopleEs knowledge of the benefits of male circumcision could influence

positive perceptions in them which could lead to increased willingness to undergo the

procedure.

9he stud! concluded that the respondents have information on the medical benefits of

male circumcision as a strateg! against acuisition of HIV infection. 9he ma>orit! of the

respondents had a positive perception of the procedure while the acceptabilit! to undergo

the procedure was generall! low.

*.) Reco$$endation

9he researcher made the following recommendations in3order to make male circumcision

an HIV preventive method that is accepted b! man! peopleF

9he heads of institutions and communit! bodies should make information on male

circumcision and other HIV prevention methods available to residents so as to increase

awareness on the role of male circumcision in preventing HIV acuisition and

transmission. 9his could be achieved b! inviting speakers on the sub>ect and through

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sourcing literature on the sub>ect. 9his can also change some of negative perceptions

mentioned in this stud!.

9o promote the uptake of M


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?irhahenbuwa,


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+him>i ?. M.), #$$$, In%ant $a(e circu$ciion A 6io(ation o% the Canadian Charter

o% Right and reedo$, Health 6aw #$$$,

www.cirp.orgDlibrar!DlegalD#$'$D'#D'# D


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Halperian ).9, :rit5 *, Mc:arland W, Woelk G, #$$7, Acce&ta'i(it! o% adu(t $a(e

circu$ciion %or e5ua((! tran$itted dieae and HI6 &re,ention in

i$'a';e. Be- 9ransm )is %#J#%83#%0

Hargrove KW " Mahomva ?, et.al, #$$7. Dec(ining Pre,a(ence and incidence in

;o$en attending $aternit! c(inic in


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6eed! /) and Ormand.K, (#$$7. Practica( Reearch: P(anning and Deign. /erson

/rentice Hall, Aew Kerse!

6ukobo M.), +aile! 1


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A!amuda, /. (#$$#. Organiationa( (eaderhi& in 4ater o% Buine Ad$initration

7#%. Cimbabwe Open @niversit! Harare.

Bcott, +., Weiss H. ? and Vil>oen K. I, #$$7, The acce&ta'i(it! o% $a(e circu$ciion

a an HI6 &re,ention a$ong a rura( u(u &o&u(ation@ =;au(u9Nata(@

#outh A%rica@?I)B


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Westercamp, Aelli and 1obert +aile!. #$$. Acce&ta'i(it! o% $a(e circu$ciion %or

&re,ention o% HI6AID# in #u'9#aharan A%ricaJ ? review. ?I)B

+ehavior,

Winkel 1. #$$7, 4a(e Circu$ciion in the U#AJ ? Human 1ights /rimer, Missouri,

@B?.

Wiswell 9. The &re&uce@ urinar! tract in%ection@ and the coneGuence . /ediatrics.

#$$$F '$7J8&$;8

9roparg


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APPENDIK 1

BINDURA UNI6ER#IT? O #CIENCE EDUCATION

ACU7T? O #CIENCE EDUCATION


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'$. What are the benefits of male circumcision

SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS


S

''. )o !ou know of an! complications that ma! arise from the procedure (/lease list


SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

'#. Is male circumcision practiced in !our traditionDculture or 1eligion LesDAo

'%. If !es what is the basis of the practice. /lease e-plain.


SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS.

'2 /lease e-plain how !ou view D perceive male circumcision



'7. Male circumcision is being practiced in some countries and in some regions of this

countr!. )o !ou think male circumcision should be practiced in these current da!s or

should have stopped long back

Bhould be provided Bhould have

'&. /lease e-plain !our answer to '7 above



'. 9his uestion is for people with male children. ?re !our male children circumcised

LesD AoD Aot applicable

'8. ?re !ou circumcised LesD AO

'0. If !ou answer to '8 above is !es, how was the procedure conducted

9raditionall! Medicall! )o not have

information

#$. ?t what age were !ou circumcised

&&


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+efore

adolescence

)uring

adolescence

?fter

adolescence

#'. Is male circumcision of an! benefit to !ou Les DAo

##. If !our answer to #' above is !es, what are the benefits



#%. If !ou are not circumcised, would !ou accept to be circumcised Les D Ao

#2. /lease give reasons for !ou choice to #% above.



#7. In the event of being blessed with bab! bo!(s, would accept to have himDthemcircumcised LesD Ao

#&. /lease e-plain wh! !ou would accept or den!


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BINDURA UNI6ER#IT? O #CIENCE EDUCATION

ACU7T? O #CIENCE EDUCATION


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Ordinar!

level

?dvanced

level

)iploma )egree

0. What do !ou understand b! male circumcision



'$. What are the benefits of male circumcision


SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

''. )o !ou know of an! complications that ma! arise from the procedure (/lease list

SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

'#. Is male circumcision practiced in !our traditionDculture or 1eligion LesDAo

'%. If !es what is the basis of the practice. /lease e-plain.



SS

'2 /lease e-plain how !ou view D perceive male circumcision



'7. Male circumcision is being practiced in some countries and in some regions of this

countr!. )o !ou think male circumcision should be practiced in these current da!s or

should have stopped long back

Bhould be practiced Bhould have

stopped long back

'&. /lease e-plain !our answer to '7 above



$


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uestion ' and '8 are for people with male children.

'. ?re !our male children circumcised LesD Ao D Aot applicable

'8. If !ou answer to the above uestion is !es, how was the procedure done

9raditionall! Medicall!

'0. In the event of being blessed with bab! bo!(s, would accept to circumcise

him( themLesDAo

#$. /lease give reasons to !our choice in '0 above.


SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS#'. @nder what conditions would !ou prefer male circumcision to be conducted

9raditionall! Medicall!

##. Is male circumcision of an! benefit to !ou LesD Ao

#%. If !es what are the benefits


SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS..

#2. )o !ou there is need for males to be circumcised LesD Ao

#7. If !our answer to #2 above is !es, please e-plain the need for the procedure.


SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS..

#&. Given the option to choose a male partner, what would be !ou preference in terms of

circumcision state


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SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS..

1ecent scientific studies have reviewed that medicall! performed male circumcision

reduces the rate of acuisition of HIV in males b! &$4. However it does not offer total

prevention against HIV acuisition. Would this information make !ou change !our

opinionD perception about male circumcision

#8. If so how does !our perception of male circumcision change


SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

#0. )o !ou think there is need to embark on a nationwide programme to circumcised

males LesD Ao

%$. If !our answer to #0 above is !es, what age group would !ou suggest to be the ideal

to target group

Infants @nder fives +efore

adolescence

?t adolescence ?dults

%'. )o !ou have an! suggestion on how male circumcision can be promoted to be one of

the prevention methods of HIV transmission



SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

9hank !ou ver! much for !our cooperation. Ma! !ou be blessed in ever!thing !ou do

APPENDIK "

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Documents

impact of male circumcision in chitungwiza