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O23.5 “Circumcision Makes Them Half Men”: Concerns About Loss of Masculinity May Deter Acceptance of Safe Medical Male Circumcision
  1. P Lilleston1,
  2. A V Marcell2,
  3. N Nakyanjo3,
  4. L Leonard1,
  5. M J Wawer4
  1. 1Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
  2. 2Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
  3. 3Rakai Health Sciences Program, Entebbe, Uganda
  4. 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States


Background Despite access to safe medical male circumcision (MMC) and the proven effectiveness of the procedure in reducing acquisition of HIV and other STIs, uptake remains relatively low in Rakai District, Uganda. Gender may play an important role in use of HIV prevention services, yet few studies have examined linkages between beliefs about what it means to be a man and acceptance of MMC.

Methods We explored this relationship in focus group discussions (n = 34 groups) with men and women in Rakai. Focus groups were conducted from May through July, 2012 with adolescent and adult males with a range of HIV risk and reproductive health service use profiles, and with adolescent and adult females. Data were analysed using Atlas-ti and an inductive approach.

Results Participants’ beliefs about manhood were grounded in the concepts of responsibility (signified through provision of economic and social stability in the family), independence, sexuality, fertility, and religiosity. While some participants described MMC as leading to more pleasurable sex and better hygiene, other aspects of MMC were perceived as threatening valued aspects of manhood. For instance, the post-surgical healing period required time off work and increased dependence on family support. Males worried about restrictions on sexual activity during the healing period and the perceived side-effects of the procedure, such as reductions in sexual drive. Some Christian participants equated male circumcision with religious conversion or the desecration of the body as God’s creation. Women reported that MMC could be an indicator of infidelity in a relationship, inciting conflict between sexual partners.

Conclusion In considering MMC, males weighed the potential benefits of avoiding HIV infection in the future against more immediate threats to their sense of self as men. Understanding how males and females view MMC is a crucial step towards increasing uptake of the procedure and reducing disease transmission.

  • Medical Male Circumcision
  • STI Prevention
  • Uganda

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