Incorrect beliefs about male circumcision and
female HIV infection risk among men and
women in Malawi
Brendan Maughan-Brown
SALDRU, University of Cape Town
Susan Godlonton
Ford School of Public Policy, University of Michigan
Rebecca Thornton
Department of Economics, University of Michigan
Atheendar Venkataramani
Department of Medicine, Massachusetts General Hospital
July 21, 2014
Research Question
• Do individuals who learn that MC reduces female-tomale HIV transmission also infer a reduction in direct
male-to-female HIV risk (i.e. from an HIV-positive man
to an uninfected woman)?
• Individuals were asked about the number of women (out of 100) who
would contract HIV after sleeping with a circumcised or uncircumcised
HIV+ man.
• Similar questions were asked about the risk of contracting HIV for
circumcised versus uncircumcised men with an HIV+ woman.
Study design
2008
1224 men
interviewed
Random
assignment
2009
Control
468 re-interviewed
Intervention
484 re-interviewed
1-on-1 discussion:
MC & Male HIV risk
+
431 Women
interviewed (wives
of male sample)
Key Findings
• 72% of men and 82% of women who believed that MC reduces a man’s
risk of HIV infection also believed that MC directly reduces a woman’s
HIV risk.
• On average, the greater the extent to which MC was believed to reduce
HIV risk for men, the greater the extent to which MC was believed to
reduce HIV risk for women:
Key Findings
• 50% of men who were randomized to information that MC reduces a
man’s risk of HIV infection (intervention) believed that MC reduces HIV
risk for women compared to 38% in the control group.
• The belief that MC directly reduces HIV infection risk for women
appeared to be driven by beliefs that MC protects men:
Implications
• Results add to emerging evidence of beliefs that MC protects women held in
different regions of southern Africa.
• These beliefs may decrease the ability of women to negotiate condom use with
circumcised partners.
• An explanation for evidence of risk compensatory behaviours among women?
• Individuals may actively project the messages of information campaigns to
groups that do not actually benefit from a particular intervention or change in
behaviour.
• VMMC information campaigns should explicitly state that MC has not been
shown to offer any direct HIV protective benefits for women.
• Caveat: Be careful not to confuse messages about MC and male HIV infection risk.
• Further research: Understand the consequences of such incorrect beliefs.
Acknowledgments
We would like to thank Martin Abel, Nicola Branson, Arden Finn, David MaughanBrown, Rebecca Maughan-Brown, Elizabeth Gummerson, and Edward Okeke for
helpful comments and suggestions. Brendan Maughan-Brown is grateful for funding
from the National Research Foundation (NRF) Research Chair in Poverty and
Inequality Research for his Postdoctoral Research Fellowship. Atheendar S.
Venkataramani is grateful to the Massachusetts General Hospital Global Primary
Care Program for travel and research support. We acknowledge the extensive
contributions of the field team including James Amani, Sheena Kayira, Collins
Kwizombe, Denise Matthijsse, Ernest Mlenga, and Christopher Nyirenda. We also
thank assistance from Kondwani Chidziwisano, Jessica Kraft, Erica Marks, Julie
Moran, Jason Stanley, and Kondwani Tomoko. Funding for this study was provided
by Michigan Center for Demography of Aging (MiCDA), OVPR and Rackham at
the University of Michigan as well as the Institute for Research on Women and
Gender. Godlonton and Thornton gratefully acknowledge use of the services and
facilities of the Population Studies Center at the University of Michigan, funded by
NICHD Center Grant R24.