Adams Alfred Khehla, Day Sarah, Pienaar Jacqueline, Dlamini Ndumiso, Ndlovu Kudzayi, Mangara Paul
Centre for HIV/AIDS Prevention Studies (CHAPS), Mbabane, Swaziland.
Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
Cult Health Sex. 2022 Sep;24(9):1168-1180. doi: 10.1080/13691058.2021.1933185. Epub 2021 Jul 8.
Compelling evidence from three randomised controlled trials, which showed that voluntary medical male circumcision (VMMC) reduces HIV acquisition from women to men by up to 60%, led to WHO recommending that VMMC be implemented in 14 priority countries. As one of the priority countries, Eswatini aimed to reach 80% VMMC coverage among boys and men aged 10-49 years since programme inception in 2009. By the end of 2019, however, the country had reached a modest 40%. VMMC is intrinsically tied to perceptions of masculinity and male gender identity. Comprehending the role of context-specific masculinity as it relates to VMMC may contribute to our understanding of community attitudes towards VMMC and men's decision-making. Drawing on focus group discussion data, this study aimed to explore the linkage between sexuality, masculinity and health interventions within Eswatini. Using critical discourse analysis, the study identified two discourses: sexuality, masculinity and circumcision, and income, masculinity, and circumcision. In the first discourse, participants constructed discursive linkages between circumcision as an adult and loss of penile sensitivity, decreased libido and sexual performance, and adverse events. The second discourse, income, masculinity, and circumcision located circumcision within the social and material realities faced by Swazi men, gender norms and provision within family structures.
三项随机对照试验提供了令人信服的证据，表明自愿男性医学包皮环切术可将女性向男性传播艾滋病毒的几率降低多达60%，这促使世界卫生组织建议在14个优先国家实施该手术。作为优先国家之一，自2009年项目启动以来，斯威士兰旨在使10至49岁的男孩和男性中自愿男性医学包皮环切术的覆盖率达到80%。然而，到2019年底，该国仅达到了适度的40%。自愿男性医学包皮环切术与男性气质和男性性别认同观念有着内在联系。理解特定背景下的男性气质与自愿男性医学包皮环切术的关系，可能有助于我们理解社区对该手术的态度以及男性的决策过程。基于焦点小组讨论数据，本研究旨在探讨斯威士兰性取向、男性气质与健康干预措施之间的联系。通过批判性话语分析，该研究确定了两种话语：性取向、男性气质与包皮环切术，以及收入、男性气质与包皮环切术。在第一种话语中，参与者构建了作为成年人的包皮环切术与阴茎敏感度丧失、性欲和性功能下降以及不良事件之间的话语联系。第二种话语，即收入、男性气质与包皮环切术，将包皮环切术置于斯威士兰男性所面临的社会和物质现实、性别规范以及家庭结构中的供养情况之中。
