A longitudinal study on women's knowledge and attitude towards male circumcision, and its influencing factors in Zambia

Abstract

Background: In Zambia, male circumcision is known to be practised in some parts of the country for traditional, health, and other reasons. Due to scientific evidence that has shown that male circumcision provides protection from HIV transmission to men, the government embarked on a male circumcision scale up program. The study aimed to investigate Women’s Knowledge and Attitude towards Male Circumcision and its influencing factors between 2011 and 2013. Method: The study was a longitudinal study and sampled a total of 1350 women aged 15-29 between years. The study analysed three rounds of data collection. The type of analysis involved univariate, bivariate and multivariate. Ordered logistic regression or proportional odds model (POM) was fitted to predict women’s knowledge and attitude towards male circumcision. Results: The mean age was 21.8 years. The majority were married (48.9%) and followed by single (45.2%). Only less than a quarter (20.2%) of the total married women had circumcised partners. Close to three-quarters (72.5%) of the respondents were aware of male circumcision. The majority (38%) had poor knowledge at baseline. However, in Round two (44%) and Round three (49%), the majority of women had average knowledge of male circumcision. The increase in knowledge in each successive study round was statistically significant at 95% CI, (P<0.001). The study reveals that women’s knowledge was influenced by factors such as; a woman’s age, a woman’s education level, ethnicity, region, marital status, hearing of male circumcision, talking to a spouse, boyfriend or sex partner and lastly talking to a family member on male circumcision. With regards to attitude, the majority (60%) of women at baseline had neutral attitude towards male circumcision. However, the majority in Round two (54%) and Round three (67%) had a positive attitude towards male circumcision. The change in women’s attitude towards male circumcision was statistically significant with p-value <0.001. that women’s attitude towards male circumcision can be explained by factors such as; a woman’s age, her religion, seeing promotional materials on male circumcision, talking to a circumcised person, a boyfriend, sexual partner or a spouse. Discussion and Conclusion: It is evident from the findings that male circumcision campaigns may have failed to correctly educate women on the level of protection MC offers to both men and women. Women had misconceptions on the extent to which MC offers protection. This has implications on risk compensation as women may engage in risky sexual behaviour as they not only believe MC is fully protective of HIV but it also offers protection to women. The exhibited misconceptions may have other implications on women such as gender based violence and reduced negotiating power for safer sex. Nevertheless, women had a positive attitude indicating a favourable environment for scale up of MC.