Gender integration

Gender integration in VMMC means involving female partners and family members in the decision-making surrounding VMMC services, counseling and education, and post-procedure wound care.

Female partners and caregivers play an important role in VMMC decisions and post-operative care. One study in Zambia showed that discussing circumcision with a female sexual partner was the greatest predictor of readiness to undergo VMMC.  Female partners and caregivers can encourage uptake of VMMC, appropriate post-operative care, and adherence to the abstinence period; but female partners and caregivers can also discourage VMMC and hinder good VMMC client outcomes if they are not informed and propagate misconceptions.  There are also harmful gender-related myths that should be addressed in client counseling and education to promote good outcomes (e.g., sex with a virgin or multiple partners other than spouse following VMMC to promote healing or spiritual protection).

It is also important that VMMC counseling does not leave clients with the belief that women are the primary transmitters of HIV.

Quality issues:

  • Assuring that demand creation and mobilization activities discuss the advantages of female involvement, as sexual partners, mothers, sisters, caregivers, etc.
  • Making couples’ VMMC counseling available and attractive (e.g., offering services targeting female partners at outreach sites)
  • Assuring that client counseling and education:
    • Makes clear that VMMC does not afford HIV prevention protection for the female partner but does reduce the risk of other STIs, including HPV (which can lead to cervical cancer)
    • Does not blame women for HIV or imply women are primarily responsible for HIV (since VMMC reduces the likelihood of female-to-male transmission of HIV through penile-vaginal sex)
    • Emphasizes the importance of condom use for HIV prevention
    • Discusses the value of VMMC post-operative care with female partners
  • Poor adherence to six-week abstinence
  • Assuring that partner HIV testing is encouraged in client counseling and education
  • Assuring availability of educational materials targeting female partners