Added: Tanja Sherrick - Date: 12.02.2022 04:20 - Views: 46657 - Clicks: 2399
While female involvement in voluntary medical male circumcision VMMC has been studied among adults, little is known about the influence of adolescent females on their male counterparts. Across 3 countries, 12 focus group discussions were conducted with a total of 90 adolescent females aged 16—19 years. Individual in-depth interviews were conducted 6—10 weeks post-VMMC with 92 adolescent males aged 10—19 years.
Transcribed and translated qualitative data were coded into and sub by 2 independent coders. Regardless, females from all countries expressed preference for circumcised over uncircumcised sexual partners. Adolescent females believed VMMC to be beneficial for the sexual health of both partners, viewed males with a circumcised penis as more attractive than uncircumcised males, used their romantic relationships with males or the potential for sex as leveraging points to convince males to become circumcised, and demonstrated supportive attitudes in the wound-healing period.
Interviews with males confirmed that encouragement from females was a motivating factor in seeking VMMC. Adolescent female participants played a role in convincing young males to seek VMMC and remained supportive of the decision postprocedure. Programs aiming to increase uptake of VMMC and other health-related initiatives for adolescent males should consider the perspective and influence of adolescent females.
Voluntary medical male circumcision VMMC reduces the risk of acquiring human immunodeficiency virus HIVhuman papillomavirus, and herpes simplex virus type 2 among men [ 1—10 ], and Trichomonas vaginalisbacterial vaginosis, and human papillomavirus among female partners [ 11—13 ]. Women also benefit indirectly from the expansion of VMMC services because the probability of encountering an HIV-infected male partner gradually declines with programmatic scale-up [ 14 ].
While female involvement in VMMC decision making has been studied among adults [ 17—19 ], little is known regarding the influence of female peers on adolescent VMMC clients. Research on adolescents in Dating seeking circumcised Africa shows that peers have a large impact on adolescent sexual and reproductive health behaviors [ 20—26 ]. This study utilized focus groups with female adolescents aged 16—19 years and in-depth interviews IDIs with male adolescents aged 10—19 years to explore the influence and support of adolescent females in the decision-making and healing process for male peers and sexual partners receiving VMMC across 3 countries: South Africa, Tanzania, and Zimbabwe.
Female adolescent participants were recruited from the communities in which VMMC clinics were located, and male adolescent participants were recruited from 4 VMMC sites per country, as ly described [ 27 ]. Female participants were not necessarily sexual partners of VMMC clients. This timeframe was selected to allow for completion of the full post-VMMC healing period and any follow-up appointments. Male participants were recruited at the health facility by trained research coordinators working with VMMC mobilizers on the day of their procedure or VMMC providers during their follow-up appointment, as ly described [ 28 ].
Interviews were conducted in private settings by local, trained facilitators in English or Dating seeking circumcised languages: Sesotho, isiZulu, or isiSwati in South Africa; kiSwahili in Tanzania; Shona or Ndebele in Zimbabwe. Interviews were audio recorded, transcribed, and translated into English. Two coders independently coded transcripts using Atlas. The 2-step coding process included an initial independent read-through of all transcripts by each coder to develop a coding scheme.
The coders then discussed any differences in the scheme until a consensus was met. Research staff double-coded all transcripts, and when further content analysis arose, coders generated themes and subthemes within predetermined areas of inquiry in the semistructured interview guides. Coders compared all applied codes and discussed discrepancies until an agreement was reached. In the rare event that an individual code resulted in no agreement between coders, the primary investigator made a final determination.
Table 1 shows the participant demographics overall and by country. Table 2 displays the themes and subthemes that arose from the adolescent female and male client perspectives. Female participants believed VMMC is mutually beneficial for healthier sexual relations and considered it a modern prerequisite to date a male. When female participants were prompted regarding the benefits of VMMC, most mentioned the protection against HIV infection, sexually transmitted infections, and cervical Dating seeking circumcised in the female sexual partners of circumcised males. It reduces the chances of contracting diseases like HIV, cancer …especially HIV—that is the one we dread most as young people who are still growing up.
Adolescent females from all 3 countries expressed their overall preference for circumcised sexual partners. They [circumcised males] would have done a good thing because they would have protected themselves from sexually transmitted diseases. He would have helped me He would have helped himself and me as well in terms of preventing sexually transmitted diseases. So it is good to be circumcised. Female, age 18, Mutare, Zimbabwe. I think it is a must [to receive VMMC], not a matter of choice, of willingness.
The world we live in today is different because there are so many diseases, unlike how the situation was back in the days when people could live without being circumcised and still not risk getting diseases. So because circumcision helps in reducing the risk of diseases, I think it is a must for every male to be circumcised.
Female, age 19, Makambako, Tanzania.
While many females shared that they admired males who underwent the procedure, some were skeptical and believed males would use their circumcised status as an opportunity for promiscuity. He is the same as before even though he is circumcised. He will take advantage now that he is safe and do crazy things. Female, age 16, Ermelo, South Africa. Male adolescents reported that VMMC was a personal matter not to be discussed with others. Most adolescent males across all countries reported they rarely considered the opinions of their female peers and platonic friends when deciding to seek VMMC.
Some males even reported not feeling comfortable talking with female friends about their VMMC status, citing shyness and fear of being ridiculed or mocked. Male, age 14, Mutare, Zimbabwe. This fear of potential embarrassment or ridicule from disclosing VMMC status was observed in all countries.
Female adolescents also explained that their male friends often did not feel comfortable talking about VMMC with them. Very few boys can talk about their circumcision experience with girls; they talk about it among themselves. If they talk about it with girls, then they must be very confident. Female, age Dating seeking circumcised, Makambako, Tanzania. Male adolescents in relationships appeared to include partners in the decision-making process.
She [my girlfriend] used to nag me every day and told me that I needed to get circumcised … she told me that I have made the right decision, and our love has blossomed even more. Male, age 18, Mbeya, Tanzania. While only a few males reported their girlfriends directly influenced their decision to undergo VMMC, others mentioned such encouragement as a motivating factor.
Most female participants in Tanzania and Zimbabwe disclosed they would not initiate relationships or would readily discontinue them if their partners refused VMMC. I would encourage [my boyfriend]. Female, age 17, Orange Farm, South Africa. Some females disclosed they used the power of maintaining the relationship as leverage:. If a male knows his girlfriend loves him, and she tells him to do anything, he would listen to her. As for me, if he does not accept to go and get circumcised, I would leave him for the one who has.
He must listen and accept to be circumcised if he wants to keep the relationship. Female, age 19, Dating seeking circumcised, Tanzania. Overall, male adolescents noted that Dating seeking circumcised preference for dating or having sex with circumcised males is a factor in their VMMC decision making.
Many female adolescents mentioned that having a circumcised male partner not only means feeling protected from HIV transmission, but appears more hygienic and sexually appealing. Females also mentioned that sex was more pleasurable with a circumcised as compared to an uncircumcised partner because of a belief that a circumcised male can prolong sex. He will not come too early [when circumcised]; he will do so after some time has elapsed.
It helps you to also enjoy [sex] as a woman. Female, age 18, Mount Darwin, Zimbabwe. Likewise, male adolescents believed VMMC would enable them to sexually satisfy their female partner. Male, age 18, Ermelo, South Africa. According to both genders, males seemed more confident overall following VMMC because they were more comfortable with their appearance. One young male reportedly hid the fact that he was not circumcised and felt scared a female would find out until he finally underwent VMMC:. To be sincere it was embarrassing [to not be circumcised], and I was feeling bad, because even when you want to urinate you will have to go to a place where nobody will see you.
And also there was a certain feeling that makes you to be uncomfortable as a man. For instance, when you approach a girl, you cannot be straight to her [about your circumcision status] … you become scared. She can agree [to have sex] but yet you are scared … you run away.
Male, age 19, Iringa, Tanzania. Gaining confidence when approaching partners for sexual encounters was a benefit reported by both males and females. They [circumcised males] become more confident, because even when they are with a female partner they are more comfortable. A person cannot be comfortable with his partner if he is not circumcised. He could even prefer to have sex when the lights are off.
After he is circumcised, he becomes free and comfortable. At the same time, some adolescent females did not approve of this gain in confidence, since they felt that males become more promiscuous following the procedure. Female, age 19, Bulawayo, Zimbabwe. After undergoing VMMC, male adolescents felt supported by female peers, romantic partners, and sisters. Males reported females often approached them after the procedure, wanting to know details about pain, the procedure itself, and how it changed the appearance of the penis.
My sisters know … they did not ask me a lot of questions about it because they know that I am a male and they are females, they just asked minor questions. Males rarely reported being ridiculed or mocked by female peers for their decision to be circumcised, despite having this fear prior to the procedure. In Zimbabwe, one male noted that females were more Dating seeking circumcised around recently circumcised males.
They just see [recently circumcised boys] as … they seem reluctant to play with them. They sit very far from them. They are afraid they might trigger something and you get hurt. Male, age 14, Mount Darwin, Zimbabwe. This study demonstrates that adolescent female participants endorse and influence VMMC decision making by adolescent males.
They reported leveraging their romantic relationships—or the potential for a relationship—to convince males to seek VMMC, and they remained supportive of the decision postprocedure. Adolescent males also viewed their romantic relationships as playing a role in VMMC, and they perceived females in their lives as supportive in their recovery. However, males reported being hesitant to discuss VMMC with female peers with whom they were not in romantic relationships. In general, adolescent females could be contributing to shaping social norms that encourage adolescent VMMC and that heighten stigma against those not seeking VMMC services [ 27 ].
Women in Malawi and Uganda reported greater sexual satisfaction with circumcised partners as compared to uncircumcised partners, and women perceived circumcised men as more hygienic and carrying fewer diseases than uncircumcised men [ 1930 ].
For instance, a study of adolescent and adult men seeking VMMC in Uganda found that those who were in a relationship or were married had been influenced by their female partner to seek VMMC [ 29 ].
These men expressed concern for their relationships throughout the decision process and emphasized the need to involve women in awareness-raising activities. They viewed women as holding negotiating power when communicating with Dating seeking circumcised male partners and being likely to persuade men to get circumcised, making it a t decision [ 1718 ].
Similar media campaigns may also be effective among adolescents. Some female study participants expressed concern that VMMC is a driver of promiscuous behavior. Research on risk compensation after VMMC shows this concern is unfounded—VMMC is generally not associated with an increase in the of sexual partners nor a reduction in future condom use [ 32—36 ].
Achieving greater buy-in from adolescent females for VMMC and encouraging them to play a role in convincing their male peers and romantic partners to seek VMMC services may require debunking this promiscuity myth. This study has limitations. The findings are qualitative and therefore not generalizable beyond the included participants.
It is possible that participants did not fully disclose personal details such as experience with circumcised vs uncircumcised males in the case of female participants, or male s of females ridiculing them for seeking or not seeking VMMC.
Health programs should take the perspectives and influence of adolescent girls and young women into as part of engaging adolescent male clients in VMMC and other HIV-related initiatives. We are grateful to the adolescent participants in this study for sharing their perspectives and experiences. The authors also thank the VMMC facility managers, community mobilizers, and providers for their support, and acknowledge the contributions of the Technical Advisory Group for the adolescent VMMC assessment and their guidance throughout the study.
The authors also appreciate the assistance of Meaghen Murphy with copy editing Dating seeking circumcised Maria Elena Figueroa with project startup. Financial support. Supplement sponsorship. Potential conflicts of interest. All authors: No reported conflicts of interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: of a randomized controlled trial conducted in Orange Farm, South Africa.
J Infect Dis ; : 14 — 9. Google Scholar. PLoS Med ; 2 : e Lancet ; : — Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: a randomized trial in Rakai, Uganda. J Infect Dis ; : — Factors associated with the prevalence and incidence of herpes simplex virus type 2 infection among men in Rakai, Uganda.Dating seeking circumcised
email: [email protected] - phone:(312) 915-8965 x 1808
“Now that you are circumcised, you cannot have first sex with your wife”: post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda