Traditional male circumcision in Uganda: a qualitative focus group discussion analysis

Abstract

Background: The growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC). Even though it is recommended to consider collaboration with traditional male circumcision (TMC) providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs.

Methodology and main findings: During 2010-11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events.

Conclusion: This work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches.

Figure 1. Map of Uganda.

Stars indicate locations of FGDs. Source: Central Intelligence Agency World Factbook.

Figure 2. Illustration of traditional circumcision cutting techniques by ethnic group.

Columns depict TMC cutting techniques per ethnic group. Rows show cutting process steps (row 1: pull foreskin and push glans; row 2: initial cut; row 3: secondary cut; row 4: circumcised penis).