Traditional Male Circumcision in Malawi and HIV Prevention

描述（由申请人提供）：这项为期3年的定性研究旨在研究和理解围绕传统男性割礼仪式（Jando）的文化规范、信仰和实践，作为马拉维瑶族部落中关于男子气概、健康和疾病的定义、性习俗、习俗和性伴侣的性别期望从长辈传递给年轻人的背景和机制。在一个成人患病率世界第八高的国家，瑶族占全国艾滋病病例的18%。这项研究的重点是接受男性割礼仪式的年轻人，因为这些仪式形成了将瑶族男孩融入文化性价值观和性别关系的最重要的社会文化机制。根据传统，包皮环切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。数据将分三个阶段收集，采用多方法方法，包括深入访谈、焦点小组、环境测绘、手术清查和对5个村庄的民族志观察。样本将包括：同修（7-9岁）、三组同修后（10-13岁、14-17岁、19- 20岁）、仪式的包皮环切者、管理Jando教育和监督包皮环切营的2-3名传统辅导员，以及每个同修的男性助手/支持者（Phungo）。拟议的研究将使用生命历程视角来探索和理解传统社会文化规范和男性包皮环切作为瑶族青春期地位通道的做法如何与马拉维艾滋病流行的动态交叉。此外，创新传播理论将用于研究与性行为、两性关系和艾滋病毒/艾滋病有关的信息如何通过这些仪式传播，以及仪式对未来艾滋病预防规划的潜力。这项研究恰逢其时，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病毒的传播。世卫组织呼吁开展研究，指导该手术的安全和文化上的适当使用。由于瑶族男性割礼仪式是班图族在非洲南部和其他地区广泛实行的传统的一部分，除了有利于马拉维抗击艾滋病之外，这项研究的结果也有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.