April 15, 2014
Is female participation in voluntary medical male circumcision of any value? Experiences from Uganda.by John Byabagambi, MPH
Improvement Advisor, USAID ASSIST Project/URC
Uganda adopted voluntary medical male circumcision (VMMC) as part of its comprehensive HIV prevention strategy in 2009. From its inception, the service was designed to target males and most of the efforts were focused on ensuring that as many males as possible were circumcised. In December 2012, a PEPFAR interagency team conducted an external quality assessment for the Uganda program and found several quality gaps. ... there were various myths surrounding circumcision which led to negative outcomes, and we believed that, by engaging female partners, we could educate them about the process and improve outcomes for males undergoing the procedure. Some of these harmful myths include: having unprotected sex after circumcision promotes wound healing; a painless post-circumcision penile erection is an indication of complete wound healing; as a cleansing procedure, the first post circumcision sexual encounter should be with a partner that will never come into your sexual life again; and there are possibilities that lignocaine may affect penile function and the sooner these effects are tested after surgery through sexual intercourse, the better.
... Here is a service whose main goal is to reduce the chance of HIV transmission, but what is happening is that it’s leading to behaviors that greatly promote HIV transmission because it is promoting unprotected sexual intercourse for clients with fresh wounds, which act as a direct entry portal for the virus! The myths encouraging even males who have been faithful to their partners to have multiple sexual partners - a known risk factor for HIV transmission because of the belief that they need to “cleanse themselves.” Through discussions with staff and clients we learned that it was actually the female partners that were encouraging their male partners to have intercourse with other women so that they wouldn’t transmit the bad omen to them, the most common omen being that their foreskins would peel off.
Additionally, we heard complaints in which female partners were reluctant to allow their spouses to complete the mandatory six weeks of post-circumcision abstinence to allow complete wound healing. Some circumcised clients reported that when they would inform their partners about the period of abstinence, their female partners would think that their partners were cheating on them, and that it was untrue that they must abstain for that long.