"Our [Yao people's] circumcision is of the 'brain' not of the 'penis'": factors behind the resistance to voluntary medical male circumcision among Yao people of Mangochi in Southern Malawi.

Aim: Malawi officially launched Voluntary Male Medical Circumcision (VMMC) in 2012 after the 2007 joint WHO /UNAIDS recommendation that VMMC be a key HIV prevention strategy for Sub-Sahara African region. Malawi data, however, contradicted the findings of three randomized studies conducted in Uganda, Kenya and South Africa between 2005 and 2007. While randomized trials demonstrated that male circumcision could contribute to a 60% relative reduction of HIV acquisition by men through heterosexual intercourse, HIV prevalence in Malawi was highest in the Southern Region where 47% of males were traditionally circumcised yet Central Region had 15.4% and Northern Region, 6.3%. By December 2018, Malawi had only achieved 756, 780 surgeries constituting 31% against the target of 60% of eligible men. The low achievement was due to resistance to services even in traditionally circumcising Yao communities. This study sought views of Yao respondents in Mangochi district, in Southern Malawi, on VMMC. Methods: 156 participants were interviewed (103 males and 53 females): 15 FGDs (involving 86 males and 50 females); 17 IDIs (involving 14 males, 3 females); 3 Key KIIs (involving 3 males, 0 females). For this paper, the authors only analyzed FGDs, IDIs and KIIs. Quotes from FGDs were not significant. Results: The study identified that VMMC: a) did not contribute to societal moral values; b) involved female circumcisers; c) threatened chiefs' political authority and economic gains; d) threatened continuity of jando; e) was impotent against witchcraft; f) provided by inefficient providers; g) resembled Yao circumcision; h) wrongly translated as 'm'dulidwe wa abambo.' Conclusions: The key barrier to VMMC services in Yao communities of Mangochi was the mistrust between government and implementers on one hand and Yao communities on the other due to inadequate engagement prior to the rollout of services.