Table 3 Key debates in the literature on adult male circumcision (AMC) evidence, policy and practice in Sub Saharan Africa
Type of debate | Challenge |
|---|---|
Social, cultural and religious factors | Is AMC policy culturally acceptable in this context? What are the current traditional or ritualistic practices surrounding AMC? Are there gender specific risks (i.e. FGM conflation)? |
Have risks, benefits and harm reduction been taken in to account for the social and cultural and geographic specific factors of this setting? | |
Is there willingness for adult males to be circumcised and is it acceptable to circumcise male children? | |
Can it be made clear to the public that AMC policy is being introduced as one part of a combination approach to prevention? | |
How can voices reflecting the socio-cultural context be heard and inform AMC policy and practice? | |
Messaging | Can clear and consistent communications strategies be devised that clearly demonstrate that protection from HIV is relative and not absolute? |
How can misunderstanding be minimised, so, for example male circumcision and female genital mutilation will not be conflated | |
Is it possible to create clear understanding on the importance of abstaining from sex until the wound is healed. | |
How can men and women be educated to avoid ‘risk compensation’ whereby women are at risk by circumcised men not agreeing to safe sex, or men attracting (through their new status) a large number of female partners? | |
Will AMC also protect women (through a reduction in HIV and STI incidence among men) or increase their risk of HIV infection due to disinhibition of their male partners? | |
Will provision be required to prevent conflation with FMG in this context? | |
Provider issues | Are there sufficient trained and knowledgeable medical personnel and sterile instruments in this setting? |
Will this policy create a strain on the health systems, potentially at the expense of other important interventions? | |
How will traditional male circumcision techniques be regulated to encourage safe, correct practice and prevent their higher reporting of adverse events? | |
Will human rights and ethical principles of consent be adhered to? |