MOPDE0107 - Poster Discussion
We too are shareholders: why women must be meaningfully involved in the rollout of medical male circumcision in Africa
Presented by Kawango Agot (Kenya).
K. Agot, S. Ohaga, B. Ayieko, E. Omanga, M. Kabare
Impact Research & Development Organization, Kisumu, Kenya
Background: Evidence is mixed on the benefit of
medical male circumcision (MMC) for women. Questions remain whether there is
direct benefit in reducing HIV acquisition among women; whether men put women
at risk due to early resumption of sex; whether mass rollout of MMC leads to risk
compensation in ways that compromise women's ability to negotiate condom use; and
whether MMC increases patriarchal behaviors such as gender-based violence. We present
data from various studies to address these questions and make the case for
women's shareholding position in MMC.
Methods: We reviewed over 30 published and
ongoing studies on MMC for evidence on early resumption of sex, risk
compensation, benefits of MMC to women, and women's views of and reactions to
MMC rollout in different African countries.
Results: About 10 studies have returned the verdict of no
risk compensation among circumcised men. In addition, there are few but
scientifically solid evidence emerging showing up to 47% direct benefit of MMC
in reducing HIV transmission to women, particularly when sex is not resumed
early. However, four studies show consistent evidence of early resumption of
sex before wound healing, ranging from 24-42% overall, 63-76% among married/cohabiting
men, and 12-48% among HIV-positive men. About 15 studies indicate that women
support MMC though misconceptions are still common, with up to 77% unaware of the
need for sexual abstinence. Some believe that scale-up of MMC translates into
reduced risk hence less need for safe sex.
Conclusions: With the current scale up of MMC for HIV
prevention in 14 African countries, there is no evidence of risk compensation;
however, early resumption of sex and women's low risk perception because their
partners are circumcised may undermine the benefits of MMC to women. MMC
programs should target women with correct and complete information and advocate
for their involvement in partners' decisions on circumcision.
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