Date Published: February 27, 2019
Publisher: Public Library of Science
Author(s): Blessings Msango Kapumba, Rebecca King, Richard Kao Lee.
Male circumcision (MC) reduces men’s risk of contracting HIV by approximately 60% and has the potential to significantly alter HIV epidemics. However, MC does not significantly reduce the risk of HIV transmission to women from a circumcised man. In Malawi, several researchers has examined the acceptability, accessibility and sexual behaviour change after circumcision in men but behaviour change in women following their partner’s circumcision remains uncertain. In order to fully realise the protective benefits of MC against HIV, factors related to risky sexual behaviour is imperative as some studies have shown potentials of increased risky behaviour in men following voluntary medical male circumcision (VMMC). This study aimed to explore the perceptions and opinions of female school teachers and health workers on HIV-protective benefits of MC and its impact on risk compensatory behaviour among women in Malawi.
We conducted a cross-sectional survey of women (N = 68) between May and June 2016 in three districts of southern Malawi. Risk compensatory behaviour was measured by number of sexual partners and use of protection during sex among female teachers and health care workers who are involved with educating people on benefits of VMMC. The bivariable analysis was conducted to test for association between HIV-protective benefits and risk compensatory behaviour. Purposive sampling was used to conduct eight qualitative in-depth interviews with women from the selected districts and the qualitative data was analysed thematically.
The mean age of women who participated in the survey was 30 years. Most women (94.1%) correctly indicated that HIV-positive circumcised men can still infect their partner and approximately, 90% of were knowledgeable of risky sexual behaviour for HIV. However, 55.9% perceived MC can lead women to adopt risky sexual behaviour. On the contrary to this finding, qualitative data indicate women’s misconceptions regarding their partners’ circumcision and HIV-protective benefits. Most women expressed that risky sexual behaviour such as having multiple sexual partners and inconsistent or non-use of condoms can easily be observed among women if they learn of their partners’ partial HIV-protective benefits circumcision.
Exploring women’s sexual behaviour change in the right of HIV-protective benefits of MC fills in a research knowledge important to public health. In-depth studies are therefore required to give more evidence that will guide the development of HIV risk-reduction interventions.
The findings comprise of qualitative and quantitative data from 8 structured interviews and 68 (mean age 30 years) survey responses respectively, Table 1.
Exploring women’s sexual behaviour change in the right of HIV-protective benefits of MC fills in a research knowledge important to public health. These findings suggest MC risk compensatory behaviour for HIV among women in Malawi and in other countries with similar settings. From a programmatic perspective, it is critical for all MC programmes to reiterate that beliefs about full protection of MC against HIV could potentially minimize its intended benefits. These findings have an impact on the drive to develop risk-reduction interventions. This study had four main limitations. First, the degree of risk compensation was not based on experiences from women with circumcised partners. Therefore, it was difficult to measure the extent to which risk compensation is or is not occurring among women. Second, several other studies have been conducted in the selected districts, higher awareness of MC and partial HIV protection was inevitable, compared to women in other communities where the services are just being scaled up. Third, majority of respondents in this study were married women, recruiting more unmarried women, who are less likely to have regular sexual partners, may have different perceptions of MC, and this may have yielded different results. Finally, findings are from one region of Malawi, they may not be generalizable to other countries that adopted MC in SSA. However, this study provides good basis for a larger study to be conducted across SSA countries.
The concept of risk compensation in women is new in evaluating VMMC programme outcome fitting well to the purpose of this study.