Women prefer sex with circumcised men and play key role influencing men's VMMC decision

As more men access voluntary male medical circumcision (VMMC) for HIV prevention across East and Southern Africa, evidence indicates that women are also in favour of the ongoing roll-out of this vital public health strategy.

The importance of VMMC as a biomedical intervention in a public health approach to HIV prevention is undisputed – with several randomised control trials showing it to reduce female-to-male sexual transmission of HIV by 60%.

Since 2007, the World Health Organization (WHO) and UNAIDS have recommended voluntary circumcision as a key component of HIV prevention in countries with a high HIV prevalence and low levels of male circumcision.

While the benefits for public health are clear when more men get circumcised for HIV prevention, what are women’s knowledge and perception of the procedure?

Between 2008 and 2010, medical circumcision prevalence increased from just 17% to over half (53%) of the male population in the South African township of Orange Farm, in Gauteng province – home to one of the world’s most severe HIV epidemics, with around 30% HIV prevalence among women in antenatal care.

Here three surveys were carried out, one in 2007, immediately prior to the roll-out of VMMC and a follow-up in 2010 and 2012. They found that over time, women’s perception of VMMC increased favourably, even though it was already quite positive to begin with.

In 2008, 50% of women said they preferred to have sex with circumcised men, this increased to 75% by 2012. Women also preferred to have any male children circumcised, with this number also increasing over time.

In addition, any negative opinions of circumcision held by women, such as being foolish or losing their manhood, decreased from 13.7% in 2007 to just 4.3% in 2010. Positive opinions including being responsible, protecting their health and taking control represented 79% of women’s opinions regarding VMMC. The authors note that the opinion of the women is extremely important, as they will often be the main influencing factor in a man’s life as to whether he will volunteer for the procedure.

The study results, published last month in the PLOS One Journal, are consistent with other results from countries in the region which have shown that women are positive about VMMC and welcome the roll-out. The authors comment that increasing women’s knowledge and positive perception of VMMC should be a vital part of increasing the number of men coming forward for the procedure.