Traditional Male Circumcision in Malawi and HIV Prevention

描述(由申请者提供)：这项为期3年的定性研究旨在考察和了解传统男性割礼(Jando)的文化规范、信仰和习俗，作为马拉维瑶族部落长辈向年轻人传递男子气概、健康和疾病的定义、性习俗和性伴侣的性别期望的背景和机制。在一个成人感染率位居世界第八的国家，瑶族人约占该国艾滋病病例的18%。这项研究的重点是正在接受男性割礼的年轻人，因为这些仪式构成了让瑶族男孩融入这种文化的性价值观和性别关系的最重要的社会文化机制。根据传统，割礼前后的隔离期也是允许公开讨论包括艾滋病毒/艾滋病在内的性问题的唯一时间。将采用多种方法分3个阶段收集数据，其中包括深入访谈、焦点小组、环境制图、外科手术清单和对5个村庄的人种学观察。样本将包括：启蒙人员(7-9岁)，3组后启蒙人员(10-13岁；14-17岁；19-20岁)，仪式的割礼人，管理Jando学校和监督割礼营地的2-3名传统辅导员，以及每个启蒙人员的男性服务员/支持者(Phungo)。这项拟议的研究将使用生命历程的观点来探索和理解传统的社会文化规范和做法--将男性割礼作为瑶族青春期的身份通道--如何与马拉维艾滋病流行的动态相交。此外，创新传播理论将被用来研究与性行为、性别关系和艾滋病毒/艾滋病相关的信息是如何通过这些仪式传播的，以及该仪式对未来艾滋病预防规划的潜力。这项研究也是适时的，因为新的证据表明，男性包皮环切术在帮助防止男性异性恋艾滋病毒传播方面的有效性，世界卫生组织呼吁进行研究，以指导安全和文化上适当的手术使用。由于瑶族男性割礼是整个南部和非洲其他地区普遍存在的班图传统的一部分，除了有利于马拉维抗击艾滋病之外，这项研究的结果也可能推广到非洲其他地区。

DESCRIPTION (provided by applicant): This 3-year qualitative study is designed to examine and understand the cultural norms, beliefs and practices surrounding traditional male circumcision rites (Jando) as the context and mechanism through which definitions of manhood, health and illness, and the sexual mores, customs, and gender expectations for sexual partnering are transmitted from elders to youth among the Yao tribal group of Malawi. In a country with an adult prevalence rate that is the 8th highest in the world, Yaos account for about 18% of the country's cases of AIDS. The study focuses on youth undergoing male circumcision rites because these ceremonies form the single most important socio-cultural mechanism for socializing Yao boys into the culture's sexual values and gender relationships. The period of sequestering that precedes and follows circumcision is also the only time according to tradition when matters of a sexual nature including HIV/AIDS are allowed to be openly discussed. Data will be collected in 3 Phases using a multi-method approach that includes in-depth interviewing, focus groups, environmental mapping, a surgical inventory, and ethnographic observations of 5 villages. The sample will consist of: initiates (ages 7-9), 3 cohorts of post-initiates (ages 10-13; 14-17; 19- 20), the ceremony's circumciser, the 2-3 traditional counselors who administer the Jando schooling and oversee the circumcision camp, and the male attendant/supporters (Phungo) for each initiate. The proposed study will use a Life Course Perspective to explore and understand how traditional socio-cultural norms and practices of male circumcision as a status passage at puberty among the Yao intersect with the dynamics of the Malawi AIDS epidemic. In addition, Diffusion of Innovation Theory will be used in examining how information relevant to sexual behavior, gender relationships, and HIV/AIDS is transmitted through these ceremonies as well as the rite's potential for future AIDS prevention programming. The study also is timely in the wake of new evidence showing the efficacy of male circumcision in helping to prevent male heterosexual HIV transmission, and the WHO call for research that can guide the safe and culturally appropriate use of the procedure. Because the Yao male circumcision rites are part of a widespread Bantu tradition practiced throughout southern and other parts of Africa, besides benefiting Malawi in its fight against AIDS, results of the study also are potentially generalizable to other parts of Africa.