“Our [Yao people’s] circumcision is of the ‘brain’ not of the ‘penis’”: factors behind the resistance to voluntary medical male circumcision among Yao people of Mangochi in Southern Malawi

Abstract

Aim
Malawi officially launched Voluntary Male Medical Circumcision (VMMC) in 2012 after the 2007 joint WHO /UNAIDS
recommendation that VMMC be a key HIV prevention strategy for Sub-Sahara African region. Malawi data, however, contradicted the
findings of three randomized studies conducted in Uganda, Kenya and South Africa between 2005 and 2007. While randomized trials
demonstrated that male circumcision could contribute to a 60% relative reduction of HIV acquisition by men through heterosexual
intercourse, HIV prevalence in Malawi was highest in the Southern Region where 47% of males were traditionally circumcised yet
Central Region had 15.4% and Northern Region, 6.3%. By December 2018, Malawi had only achieved 756, 780 surgeries constituting
31% against the target of 60% of eligible men. The low achievement was due to resistance to services even in traditionally circumcising
Yao communities. This study sought views of Yao respondents in Mangochi district, in Southern Malawi, on VMMC.
Methods
156 participants were interviewed (103 males and 53 females): 15 FGDs (involving 86 males and 50 females); 17 IDIs (involving 14
males, 3 females); 3 Key KIIs (involving 3 males, 0 females). For this paper, the authors only analyzed FGDs, IDIs and KIIs. Quotes
from FGDs were not significant.
Results
The study identified that VMMC: a) did not contribute to societal moral values; b) involved female circumcisers; c) threatened
chiefs’ political authority and economic gains; d) threatened continuity of jando; e) was impotent against witchcraft; f) provided by
inefficient providers; g) resembled Yao circumcision; h) wrongly translated as ‘m’dulidwe wa abambo.’
Conclusions
The key barrier to VMMC services in Yao communities of Mangochi was the mistrust between government and implementers on one
hand and Yao communities on the other due to inadequate engagement prior to the rollout of services.