Swazi men’s perception of the protective effect of male circumcision and its implications for HIV prevention strategy

Background: For years, male circumcision (MC) has been known to reduce the risk of sexually transmitted infections (STIs). Of late, MC has been recognised and recommended as a complementary HIV preventive measure in high prevalent areas. The objective of this study was to assess the perceptions of Swazi men about the protective effect of circumcision against STIs including HIV, and its implication to the mass MC strategy.
Methods: An explorative qualitative study was conducted targeting men aged ≥18 years seeking services at Family Life Association of Swaziland clinic in Mbabane, Swaziland. Unstructured individual face-to-face interviews were conducted for 17 men.
Results: Results showed that Swazi men perceived the protective effect of MC differently, ranging from perceptions of ineffectiveness and unworthy, especially against HIV, to perceptions of total protection and a solution to all STIs. Perceptions were influenced by the ongoing circumcision campaigns, individual knowledge of biological sciences, misconceptions as well as life experiences. Promiscuous men were more likely to have a positive perception and acceptance of the procedure than their non-promiscuous counterparts.
Conclusion: Swazi men hold mixed perceptions about MC, accounting for its relatively low uptake. The relatively low uptake of circumcision does not necessarily imply failure of the strategy but rather a natural selection of the most relevant and at-risk portion of the population. It is recommended that more effort be put towards correcting misconceptions and convincing those who still hold a negative perception about the procedure.

Keywords
male circumcision; HIV/AIDS; sexually transmitted infections; perceptions; Swaziland