Role of Women in Voluntary Medical Male Circumcision (VMMC) Decision Making among Men in Tanzania

Background: Given evidence of a 60% reduction in HIV acquisition for circumcised men, we examined the role of women in clients’ decision to seek services through the VMMC program implemented in the Iringa and Njombe regions of Tanzania.   

Methods: A cross sectional study was conducted including in-depth interviews (IDIs) with VMMC clients (n=30; n=12 HIV-positive), IDIs with VMMC service providers and stakeholders (n=30), and surveys with VMMC clients (n=320).  IDI transcripts were analyzed through coding and identification of key themes.  Surveys were analyzed at the univariate and bivariate level, utilizing standardized sampling weights.  

 Results: Women influenced men’s decision making for VMMC in a variety of ways.  Women interacted with the formal health care system more regularly and served as message bearers to male partners.  Among VMMC clients, 18.1% reported discussing their VMMC decision making with a wife or sexual partner.  New notions of sexual desirability were connected with male circumcision for disease risk reduction, aesthetic preferences, and sexual pleasure enhancement.   A belief that circumcision is more desirable to women was reported by 31.7% of men as one reason they decided to circumcise. However, male clients expressed discomfort with female VMMC providers and interacting with women while seeking services. Embarrassment was a main obstacle in VMMC decision making for 12.8% of clients surveyed, 40.9% believed this is an obstacle for their uncircumcised counterparts.

Conclusion: Considering these small but significant numbers, women’s ability to both persuade and dissuade men to participate in VMMC services should be considered in VMMC demand creation interventions.