Traditional Male Circumcision in Malawi and HIV Prevention

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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.