Department of Behaviour and Health, Malawi-Liverpool Wellcome Trust, Blantyre, Malawi.
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
PLoS One. 2019 Feb 27;14(2):e0211015. doi: 10.1371/journal.pone.0211015. eCollection 2019.
Male circumcision (MC) reduces men's risk of contracting HIV by approximately 60% and has the potential to significantly alter HIV epidemics. However, MC does not significantly reduce the risk of HIV transmission to women from a circumcised man. In Malawi, several researchers has examined the acceptability, accessibility and sexual behaviour change after circumcision in men but behaviour change in women following their partner's circumcision remains uncertain. In order to fully realise the protective benefits of MC against HIV, factors related to risky sexual behaviour is imperative as some studies have shown potentials of increased risky behaviour in men following voluntary medical male circumcision (VMMC). This study aimed to explore the perceptions and opinions of female school teachers and health workers on HIV-protective benefits of MC and its impact on risk compensatory behaviour among women in Malawi.
We conducted a cross-sectional survey of women (N = 68) between May and June 2016 in three districts of southern Malawi. Risk compensatory behaviour was measured by number of sexual partners and use of protection during sex among female teachers and health care workers who are involved with educating people on benefits of VMMC. The bivariable analysis was conducted to test for association between HIV-protective benefits and risk compensatory behaviour. Purposive sampling was used to conduct eight qualitative in-depth interviews with women from the selected districts and the qualitative data was analysed thematically.
The mean age of women who participated in the survey was 30 years. Most women (94.1%) correctly indicated that HIV-positive circumcised men can still infect their partner and approximately, 90% of were knowledgeable of risky sexual behaviour for HIV. However, 55.9% perceived MC can lead women to adopt risky sexual behaviour. On the contrary to this finding, qualitative data indicate women's misconceptions regarding their partners' circumcision and HIV-protective benefits. Most women expressed that risky sexual behaviour such as having multiple sexual partners and inconsistent or non-use of condoms can easily be observed among women if they learn of their partners' partial HIV-protective benefits circumcision.
Exploring women's sexual behaviour change in the right of HIV-protective benefits of MC fills in a research knowledge important to public health. In-depth studies are therefore required to give more evidence that will guide the development of HIV risk-reduction interventions.
男性割礼（MC）可使男性感染 HIV 的风险降低约 60%，并有潜力显著改变 HIV 流行。然而，MC 并不能显著降低已接受割礼的男性将 HIV 传播给女性的风险。在马拉维，一些研究人员已经研究了男性割礼后的可接受性、可及性和性行为变化，但女性在伴侣接受割礼后的性行为变化仍不确定。为了充分实现 MC 对 HIV 的保护益处，与危险性行为相关的因素是至关重要的，因为一些研究表明，在自愿男性割礼（VMMC）后，男性可能会增加危险行为。本研究旨在探讨马拉维女教师和卫生工作者对 MC 预防 HIV 益处的看法和意见，以及其对女性风险补偿性行为的影响。
我们于 2016 年 5 月至 6 月在马拉维南部的三个地区对 68 名女性进行了横断面调查。风险补偿性行为通过性伴侣数量和性保健工作者在参与宣传 VMMC 益处的女教师中使用保护措施来衡量。采用单变量分析检验 HIV 保护益处与风险补偿性行为之间的关联。采用目的抽样对从选定地区抽取的女性进行了 8 次定性深入访谈，对定性数据进行了主题分析。
参加调查的女性平均年龄为 30 岁。大多数女性（94.1%）正确指出 HIV 阳性的已割礼男性仍可能感染其伴侣，大约 90%的女性了解 HIV 危险性行为。然而，55.9%的人认为 MC 可能导致女性采取危险性行为。与这一发现相反，定性数据表明，女性对其伴侣割礼和 HIV 保护益处存在误解。大多数女性表示，如果她们了解到伴侣部分 HIV 保护益处的割礼，很容易观察到女性出现危险性行为，如多个性伴侣和不规律或不使用避孕套。
探索女性性行为变化在 MC 预防 HIV 益处方面的研究填补了公共卫生领域的一个重要知识空白。因此，需要进行更深入的研究，以提供更多的证据，为 HIV 减少风险干预措施的制定提供指导。
