Views on the Introduction of Medical Male Circumcision for HIV Prevention in South Africa

The partial efficacy (40 percent to 60 percent) of surgically conducted medical male circumcision (MMC) in preventing HIV transmission to circumcised men has been demonstrated in three clinical trials. "This research formed part of a larger study exploring the importance of integration of sexual and reproductive health with HIV services," the authors wrote, noting the objective of eliciting key informants' views on the introduction of MMC for HIV prevention in South Africa.

Semi-structured interviews were used to ask 21 key informants -- representing the South African Health Department, local and international non-governmental organizations and universities -- about their view on the issue. The interviews were transcribed, and all MMC discussions were coded for analysis using NVivo 8.

Most of the interviewees were knowledgeable about MMC for HIV prevention and indicated that making it available in South Africa was a good idea. Some recommended immediate introduction; others felt MMC should be introduced with caution.

Participants listed numerous factors that should be given consideration. These included culture, the impact of MMC on women, the possibility that behavioral disinhibition might increase risky sexual behavior, and that MMC might become another vertical health service program. Most interviewees felt that MMC should be undertaken in neonates; however, they acknowledged concerns regarding cultural responses to this. MMC implementation recommendations ranged from integrating services at the primary health care level to MMC provision by private medical practitioners.

"In conclusion, MMC is viewed as a key HIV prevention strategy," the authors wrote. "However, there are numerous factors which could hinder introduction and uptake in South Africa and in the region. It is important to explore and understand these factors and for these to be aligned in the national MMC policy."

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