title: Should female health providers be involved in medical male circumcision? Narratives of newly circumcised men in Malawi.
abstract: BACKGROUND
  The Malawi government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The "policy" recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Limited finances, acceptability concerns, and the health system's limited capacity to meet demand are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. This study explored the acceptability, by male clients, of female clinicians taking part in the circumcision procedure.
  
  
  METHODS
  Six focus group discussions (FGDs) were conducted, with a total of 47 newly circumcised men from non-circumcising ethnic groups in Malawi participating in this study. The men had been circumcised at three health facilities in Lilongwe District in 2010. Data were audio recorded and transcribed verbatim. Data were analysed using narrative analysis.
  
  
  RESULTS
  Participants in the FGDs indicated that they were not comfortable with women clinicians being part of the circumcising team. While few mentioned that they were not entirely opposed to female health providers' participation, arguing that their involvement was similar to male clinicians' involvement in child delivery, most of them opposed to female involvement, arguing that MC was not an illness that necessitates the involvement of clinicians regardless of their gender. Most of the participants said that it was not negotiable for females to be involved, as they could wait until an all-male clinician team could be available. Thematically, the arguments against female clinicians' involvement include sexual undertones and the influences of traditional male circumcision practices, among others.
  
  
  CONCLUSIONS
  Men preferred that VMMC should be conducted by male health providers only. Traditionally, male circumcision has been a male-only affair shrouded in secrecy and rituals. Although being medical, this study strongly suggested that it may be difficult for VMMC to immediately move to a public space where female health providers can participate, even for men coming from traditionally non-circumcising backgrounds.
authors.affiliation: University of Malawi, College of Medicine, Department of Community Health, Blantyre, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Umar
authors.affiliation: University of Malawi, Kamuzu College of Nursing, Lilongwe, Malawi.
authors.forename: P
authors.initials: P
authors.lastname: Mandalazi
authors.affiliation: University of Malawi, Kamuzu College of Nursing, Lilongwe, Malawi.
authors.forename: D
authors.initials: D
authors.lastname: Jere
authors.affiliation: University of Malawi, College of Medicine, Department of Community Health, Blantyre, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Muula
mesh_terms: D000293:Adolescent; D002944:Circumcision, Male / Q000208:ethnology*; D003695:Delivery of Health Care; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D008297:Male; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult