As part of a combined package of prevention efforts, voluntary medical male circumcision can dramatically reduce a man’s risk of acquiring HIV. In Lilongwe, the capital city of Malawi, the new I-TECH-supported Bwaila Voluntary Medical Male Circumcision Center recently opened its doors, ready to provide services to eligible men. But I-TECH and local leaders didn’t stop there. With funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR), they are also supporting an innovative community mobilization effort.
In this three-part series, Pius Mtike, an I-TECH Malawi male circumcision community mobilization specialist, reports on this effort.
Part III: Reaching Out to Women
If you are one of those who doubt the wisdom that laughter is good medicine, seeing the dozens of pregnant women laughing their lungs out with a group of youth interactive dramatists this month would likely change your mind. The drama group visited with women at Bwaila Hospital, in Lilongwe, to share messages about the value of voluntary medical male circumcision (VMMC). The event was organized by I-TECH Malawi and the Lilongwe District Health Office as part of community outreach efforts to generate continued demand for the procedure.
According to Alvin Chidothe Phiri, Public Relations Officer at the Lilongwe District Health Office, working with women at the antenatal section of the hospital is a good strategy. “Women play a central role in men’s lives as spouses and partners,” he said. “They hold a vital place in influencing men’s decisions and are key secondary audiences.” Also, although women are included in the models leaders use to plan outreach activities, Phiri notes that “relatively little is known about their role in decision-making around VMMC.”
The intervention was conducted partly in response to information conducted during a 2010 situational analysis for male circumcision in Malawi. The analysis, conducted by National AIDS Commission, suggested that behaviors among women may affect VMMC uptake among men. For example, women may not have the skills to advocate for VMMC with their male partners, or they may consider it an issue that is of concern to men only. The analysis also suggested that women may not know about the benefits of VMMC–both directly, for men, and indirectly, for themselves.
Women may also have other concerns, says Phiri. For example, “Many women are suspicious as to why their partner wants to undergo VMMC if they are married or in long-term relationship,” he says, adding “Women [also] have religious and cultural reservations about VMMC, [and] many . . . have [limited] communication with their male partners around sexual health issues that impact both of them.”
The interactive theater approach motivated women in the antenatal section to take turns asking questions on VMMC. As a take-home activity, the women were also encouraged to support their partners to gather more information on the facts about VMMC, and to discuss the advantages and disadvantages of VMMC. They were also urged to accompany their husbands to an HIV counseling and testing site, where they could be tested together. Many women were also interested to learn that, if their partners have the procedure, they’ll have a role in supporting them to remain abstinent for the six weeks required for proper healing.
The event was not without instant feedback: Many of the women pledged to join the campaign to promote the awareness of VMMC when they return to their respective communities.
“When I go back home, I will be talking to my friends and neighbours about VMMC and its associated benefits, and I’ll advocate that mdulidwe wa abambo (VMMC) does not change a man’s cultural or religious identity,” pledged one mother, a resident of the Mtandire area, in Lilongwe.
Read more about I-TECH’s work in Malawi.