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Why Malawian men are shunning circumcision

BLANTYRE (MaraviPost) — Costa Selemani pronounces his first name as ‘Josa’. To A Malawian ear, his accent is hard to decipher. But he boasts to his friends that his masterly of the Chichewa language is superb. He is from Mozambique’s Milange-Sede.

Wearing a red t-shirt and black pair of trousers, Selemani broke the rules of illegal trespassing and went to Muloza Health Center in Mulanje for something that many Malawian men are unwilling to undergo: circumcision.

 He is 15 years old and a Standard Six pupil at Eduardo Modilane Primary School, Mozambique. Being the first boy in the family of five, he decided to lead by example through dragging 12 year old brother, Zeque, to the centre in search of the voluntary male medical circumcision (VMMC) which is being provided by Banja la Mtsogolo under Ministry of Health.

 He was told of the VMMC by his Mozambican peers and his grandmother encouraged him to get circumcised.

 According to the team leader of the VMMC at the health centre Chimwemwe Kapyola,  the phenomenon of Mozambican boys flocking to Muloza for circumcision has become the order of the day.

“They outnumber Malawian males in seeking the services. As of November 26, 2013, only 2 of the 31 circumcised males were from Malawi. The trend has always been like this,” he says.

The VMMC is being overseen by the Ministry of Health, with service provision offered by Banja la Mtsogolo and demand creation under Bridge II Project. The programme will run from 2012 to 2017 targeting to circumcise males from the age of 12.

It is being conducted in Mulanje, Thyolo and Phalombe but is yet to go to other districts including Lilongwe and Dedza.  The question, however, is: why is the demand higher among Mozambicans than Malawians?   

In Milange-Sede, it is fashionable to be circumcised. Selemani was one of the pressured males who decided to get the ‘cut’ in search of popularity and respect from peers.  And circumcision helps men find wives easily in the Mozambican community.

 “Most women shun away from uncircumcised men so the chances of finding a marriage partner once circumcised are high. And who wants to stay unmarried?” Selemani asks rhetorically.

He also says his peers who had been circumcised before him said it helps in reducing the risk of contracting HIV and Aids which, he says, prompted him to get circumcised.

 The three districts where VMMC is providing services are predominated with Lhomwe people who by their culture undergo circumcision while young but the circumcision is different because some of the foreskin is left while the VMMC requires removal of the entire foreskin.

 Kapyola says many Malawians are shy to go for circumcision because they think it is a source of their ridicule. If other men know that one of their peers has undergone circumcision they become a laughing stock, he says.

 “There are a lot of misconceptions that men have attached to VMMC. Some believe VMMC is a way for collecting foreskins to be sold for huge amounts of money. Others believe the nurses take foreskins to use for superstitious reasons.

“A boy once insisted to take his foreskin home and I asked him, ‘Do you want to insult the male community out there?’ I took him to a pit latrine where he disposed of it. More awareness is needed to enlighten men and boys of what happens during and after circumcision.

 “VMMC is also facing the challenge of age gaps. Most married or aged men do not want to have their penises diagnosed and circumcised in front of 12 year-olds. As such, it is only young boys, if any, who come for VMMC,” said Kapyola.

During a similar tour in Thyolo, the VMMC team had little good to say of the awareness campaigns. Thyolo health education officer Fanuel Makina says the demand creation has been bad; no wonder most men want little to do with circumcision.

 “The demand creators (Bridge II Project) usually sensitise people using megaphones. If there is wind, not many will understand what has been said.

 “Maybe they could try using traditional, political and religious leaders since they are the ones who shape people’s perception – whether they are negative or positive.

 “And people need to know that circumcision is just a supplementation for HIV and Aids prevention not the cure because a lot of men get disappointed when they later learn that circumcision is not an answer to sleeping around unprotected.

 “Men also have to be told that circumcision reduces cervical and penile cancer. This can also trigger more men to get circumcised,” said Makina.

From the studies conducted since August by Ministry of Health, 98 percent of the men that go for circumcision have an HIV and Aids testing and counseling (HTC).

 Ministry of Health spokesperson Henry Chimbali says this is a good development considering that a lot of men shun HTC while women are likely to get tested when pregnant.

 MoH’s health education unit deputy director Chimwemwe Banda says there should be special and deliberate strategies to accommodate older men in VMMC.

 She suggests having two circumcision sessions – one in the morning for the young men and another in the evening for the adults.

“As we grow, there are some challenges we face in our daily life. A man does not have the same needs as a boy that is why most men would be embarrassed to get undressed in front of juveniles.

“If a man is diagnosed with an STI during the VMMC, would the boys keep it a secret or would they go about telling everyone? Maturity levels are important when it comes to nudity,” said Banda.

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