I’m a bit obsessed with male circumcision (mc) now – it was an interesting conference that I attended last week by invitation of the Bill and Melinda Gates Foundation, and it got me speaking to a lot of men that I know about mc.

I get a lot of people tweeting me or commenting on the blog whenever I write about circumcision – it’s a really controversial subject – so I want to be clear here, I don’t have a stand on circumcision. As I’m not the one who has to have a piece of their body snipped off, I only have an interest in further the debate and understanding more so that I can be informed when talking to the men in my life.

One of the issues that someone observed in this 3 day conference was not to focus solely more communication channels, and indeed more communication programmes to educate men (and women alike) on the importance of mc, but about the quality of that content. I don’t think he meant in terms of good quality productions or visuals on posters – though this does help too, but the quality of the message – what exactly are you saying?

When I spoke to men – both circumcised and not – I asked them if they’d ever consider it, and why not if they weren’t already circumcised or if they were thinking hell no to being circumcised. Quite frankly, they never understood the point in it. If we look on the HIV prevention side, circumcision reduces your risk of infection by as much as 60% BUT you still have to use a condom. Eh? So why not save yourself the bother (and the 6 week recuperation with no sex!) and just use a condom? And in the case of a man I know who does not slip, he uses condoms like they’re going out of fashion, why would circumcision ever cross his mind?

The one guy I spoke to who voluntarily got circumcised said all the right reasons – he did it because it’s hygienic, reduces risk of STIs (including HIV), reduces the risk of cervical cancer for his partner. I was getting quite impressed that here was a guy who really responded to the messages! He then went on to say that the added bonus (his words not mine) was that acquiring a few milli-inches (hmmm and he put this out on twitter! lol) and that the fellow looks more handsome! I’m not sure how he got a few more mili-inches – I don’t know how this happened as I’m not a surgeon or anything.

Ok so MC was tooted as an effective way to reduce the spread of HIV. But problem is that, try as we might, not enough men are getting circumcised and there’s a reason for this, linked back to HIV. Despite HIV having been around for like 25+ years (isn’t it over 30 now?), there is still a huge stigma attached to it. And people at the conference were talking about how people needed a cover story to get circumcised. There were also stories about women scared that if their husband’s got circumcised, then they would most likely end up being unfaithful. Erm circumcision will make a man cheat? Honey, if your man is a cheat, he’ll cheat whether he is circumcised or not.

So the next conversation was about changing the key benefit of getting circumcised, so that’s it’s not so closely linked to HIV. Hygiene for example. It is a long-term benefit after all. It’s much easier to clean a penis without a foreskin – no pulling back to clean within! This makes sense… not that I know men who don’t clean their penis’… but you never know.

I’m not a fan of changing the key benefit, reducing your chances of getting HIV is a big benefit, realistically no one knowingly wants to get HIV. But it’s got to be a no-brianer to make sex – I’m not sure 60% is good enough. Chances are still better off with a condom. Or better still no sex at all! Ok, I know, calm down, that’s not an option for many.

I think I got lost in my thoughts again – I told you I’m fascinated by this conversation about MC… oh yes, quality of content. I think I mentioned Ram in my last post. Ram is the co-founder of Final Mile (they’re behaviour architects – love that!), and he basically talked about positioning risk and rewards. Looking at the rewards of circumcision he said, and I’ll paraphrase on the issue that mc (I must stress this is medical male circumcision as opposed to traditional circumcision) may reduce risk of infection of HIV by 60%’- to which he said for ordinary people all that means is that it’s better than 50%! Which when you think about it… what does that mean? 40% is still a big risk if you ask me…

Then other rewards (that is benefits) include can reduce risk of cervical cancer, can aide in hygiene – as discussed above. After a brief pause he read out the risks! Ok – I’ll leave that for you to google.

Basically, I think when it comes to promoting medical male circumcision, if you want more men to get circumcised we need to understand what is stoping them from moving from motivation to action, and deal with that in the messaging. Yeah that was an obvious one, I know… but you’ll be surprised how few messages deal with this, probably because programme managers can be scared of what happens when you deal with the unknown, but that’s what life is about isn’t it – sometimes we have to take a calculated risk to reap the benefits – hey that could be a circumcision slogan right there!

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