The barriers and enabling factors for the uptake of voluntary medical male circumcision among "Coloured" males between the ages of 15 and 49 years in the Cape Town Metropolitan Municipality

Abstract

Voluntary Medical Male Circumcision (VMMC) has been proven to reduce heterosexual HIV transmission to men by approximately 60%. It has been argued that achieving 80% circumcision coverage among males aged 15–49 years within five years and maintaining this coverage rate in subsequent years, could avert 3.4 million new HIV infections within 15 years and generate treatment and care savings of US$16.5 billion. As a result the South African Government plans to circumcise 4.3 million males aged 15 and 49 years by the 2015/2016 financial year. However, in the Western Cape the uptake for circumcision has been poor. While there is not a great deal of knowledge out there about the reasons for the uptake (or lack thereof) of VMMC in the Western Cape, current research focus on Xhosa males predominantly. However, there is limited research on circumcision among the "Coloured" population of the Western Cape. As the "Coloured" population is the largest group in the Western Cape, this gap in research and knowledge is worth noting. The current study aimed to explore the barriers to and enablers of uptake of VMMC among "Coloured" males between the ages of 15 and 49 years in the Cape Town Metropolitan Municipality. Methodology: The study adopted a qualitative design; semi-structured interviews were conducted with seven key informants, and two focus group discussions with men who had undergone VMMC and men who had chosen not to volunteer to undergo VMMC. Thematic analysis was used to analyse the data. Results: The key enablers to uptake of VMMC were: the desire for improved hygiene; the reduction in the risk of contracting other STIs; the reduction in the risk of contracting HIV; the role of partners and family members who can encourage males to access services; the perceived improvement in the males' sexual experience and performance; and cultural reasons and religious injunction. On the other hand the key barriers that discouraged "Coloured" participants from accessing the services include: fear, particularly the fear of pain; the experience of the health services and the role of health staff; the six week healing period in which males cannot have sex; the unwillingness to alter the body that they were born with; role of partners and family as discouragers of uptake; the influence of gangsterism on the ability of males to access services offered on a different gang's 'turf'; and, substance abuse. The recommendations in this study focus largely on the need to expand the coverage of VMMC in the Cape Town Metropolitan Municipality and to increase the uptake among "Coloured" males between the ages of 15 and 49 years. . These recommendations essentially involve the need to break down the barriers and to accentuate the enablers. To this end social mobilisation campaigns should not focus solely on HIV prevention but rather on hygiene and improved sexual experience and appearance as well as the cultural and religious aspects. With regard to the barriers it is essential that any social mobilisation engages with the fear of pain. On method to do this would be through the introduction and expansion of the PrePex™ device. The fear that circumcision could impact on sexual performance and the fear of embarrassment and discomfort the whole process would potentially bring would need to be allayed. In addition it is essential that the health services and health staff are orientated and trained in a way that ensures that the process of circumcision is as easy as possible for the clients.