The Demand for Medical Male Circumcision

This paper presents results from analysis of 64 in-depth interviews with urban men embedded in an experimental quantitative study of demand for medical male circumcision for HIV prevention in Malawi. Despite having expressed genuine interest in circumcision, few study participants (three percent) opted to actually undergo the surgery. The qualitative interviews shed light on the gap between favorable attitudes and actions, demonstrating that a crucial element of the decision-making process is consultation with social networks. Social networks can be a source of scary rumors about circumcisions gone wrong. At the same time, men also receive support and encouragement to undergo the surgery. Feedback from social networks additionally influences how men deal with structural barriers to obtaining a circumcision, such as costs associated with the surgery and healing period. In these ways, reactions from peers affect decisions regarding uptake of circumcision. Another implication of these findings is that this consultation process takes time. Attention to the role of social networks in the adoption of medical male circumcision and allowing for the time needed for consultation is crucial for the success of male circumcision scale-up for HIV prevention.