Rolling-out medical male circumcision: making it work for women and promoting gender equality

Sonke Gender Justice

The increased availability of bio-medical HIV prevention approaches, like medical male circumcision (MMC), mark an important step towards reducing HIV infections. However, it is important that these methods not be divorced from the social contexts in which they are implemented, especially cultural and gender factors.

Sonke’s initiatives to promote MMC

In partnership with Artist Proof Studios, Sonke has been granted funding by the South African Development Fund (SADF) and AVAC: Global Advocacy for HIV Prevention to:

  • Develop a series of materials, including comic strips, educating people about and promoting MMC and creating awareness about the gender implications of MMC.
  • Implement an MMC research advocacy project by integrating a stronger focus on gender equality education within the roll-out of male circumcision in South Africa.

Roll-out of MMC in South Africa

South Africa is one of the few countries that explicitly includes MMC in its HIV and AIDS National Strategic Plan, though we do not yet have an official policy on MMC. However, there is growing support for MMC and activitists (including Sonke) will be pushing for a coherent MMC policy that includes a focus on gender.

Towards the end of 2010, male circumcision received support from two important (and vastly different) sources:

  • the Zulu king, King Goodwill Zwelethini, who has honoured circumcised men, creating an increased demand for MMC in KwaZulu-Natal, and
  • the Global Fund made $33 million available for MMC for the period 2011-2012.

MMC and Women

MMC does not directly protect women from HIV infection. It provides indirect benefit to women by reducing the number of men who are HIV infected, thereby decreasing male-to-female HIV transmission.

Concerns have been expressed about the ways in which MMC may impact negatively on women, in terms of increased stigma and possible increased violence against women. There are also (as yet unproved) concerns about circumcised men participating in more risky behaviour due to perceptions of immunity.

This is a key focus for Sonke’s work on MMC.

The Case for MMC

Three randomised clinical trials in South Africa, Uganda and Kenya have concluded that MMC can reduce men’s risk of becoming infected with HIV by about 60% because:

  • The foreskin has high concentrations of target cells that are very susceptible to HIV infection.
  • The underside of the foreskin is susceptible to micro tears and trauma during sexual intercourse that provides an entry point for HIV infection.

After complete circumcision, the skin of the penis thickens and becomes a stronger barrier (like skin on other parts of the body) to HIV infection. Although, it has been clearly proven that MMC significantly lowers the risk of heterosexual HIV transmission for men it does not directly protect women, and there are concerns that it may have harmful consequences for women if condom-use decreases as a result, or if women become stigmatised as carriers of HIV. There are even concerns that there may be an increase in gender-based violence related to condom negotiation.