Traditional Male Circumcision in Malawi and HIV Prevention

描述（由申请人提供）：这项为期3年的定性研究旨在检查和了解传统男性包皮环切仪式（Jando）的文化规范，信仰和做法，通过这种背景和机制，成年人，健康和疾病的定义，以及性道德，习俗和性伴侣的性别期望从马拉维的瑶族部落群体中的老年人传递给青年。在一个成年人患病率居世界第8位的国家，瑶族占全国艾滋病病例的18%。这项研究的重点是年轻人接受男性割礼仪式，因为这些仪式形成了单一的最重要的社会文化机制，使瑶族男孩融入文化的性价值观和性别关系。在割礼前后的隔离期也是传统上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。将使用多种方法分3个阶段收集数据，包括深入访谈、焦点小组、环境绘图、手术清单和5个村庄的人种学观察。样品将包括：参加仪式的人员包括：新入行者（7-9岁）、3组后入行者（10-13岁; 14-17岁; 19- 20岁）、割礼师、2-3名负责管理Jando学校教育和监督割礼营的传统顾问，以及每位入行者的男性服务员/支持者（Phungo）。拟议的研究将使用生命历程的角度来探讨和了解传统的社会文化规范和做法的男性包皮环切作为一个状态通道在青春期之间的瑶族交叉与马拉维艾滋病流行的动态。此外，创新理论的传播将用于研究如何通过这些仪式传播与性行为，性别关系和艾滋病毒/艾滋病有关的信息，以及仪式对未来艾滋病预防方案的潜力。这项研究也是及时的，因为有新的证据表明男性包皮环切术有助于预防男性异性恋艾滋病毒传播，世卫组织呼吁进行研究，以指导安全和文化上适当地使用该程序。由于瑶族男性割礼仪式是非洲南部和其他地区广泛实行的班图传统的一部分，除了有利于马拉维防治艾滋病外，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.