The findings presented reflect the key themes that emerged from data analysis. Overall,
MC was perceived negatively, contradicting the findings of the MC acceptability studies
carried out prior to the MC intervention (Lagarde et al., 2003; PSI, 2010; Tsela &
Halperin, 2006; Westercamp & Bailey, 2007). This finding seems accurate, especially
given the low numbers of men who accessed services during the campaign (WHO, 2012).
Our ethnographic approach allowed for a free exchange between researcher and

Both the tone and content of these discussions made it apparent that many men viewed
circumcision with deep ambivalence, expressing concerns about the fear of loss of sexual
pleasure and unwillingness to undergo a surgery that would only result in partial
protection, issues which, notably, were not addressed in the public health circumcision
campaign.

Our research shows that, contrary to what was reported in previous acceptability studies,
fear of pain was not a significant barrier to uptake.

Interestingly, younger men and adolescents expressed greater worries about
pain, but they were also more likely to undergo circumcision surgery than were the older
men, who did not seem too concerned about pain.

I hear them say that it reduces the chances of getting HIV and other diseases but I do not
think the penis head remains as sensitive as it was before, because it gets dry.

A 31-year-old circumcised man said in an FGD:
A friend of mine lied to me and he said after getting circumcised I would enjoy sex better.
Also, the MC Ambassador was telling us that you would enjoy sex better after circumcision.
But now it (penis head) is almost like rubber and there is no longer that feeling when
entering the female.

Such statements were common and representative of the men we interviewed. It appears
that individual men who have undergone circumcision in Swaziland routinely complain
to their peers about loss of sexual pleasure following the surgery and, further, that such
conversations are more likely to influence men’s expectations of sexual pleasure and
performance following circumcision than are the public health campaigns, which went so
far as to promote circumcision as a sexual enhancer in Swaziland, without being explicit
about what such enhancement might entail.

Does it not happen that they make a mistake? A neighbor of mine got circumcised and he
took a very long time to heal. As people we heal differently and some take too long and you
find that you have a swollen penis for weeks and the penis does not get back to its original
state.

... my friend got circumcised and his penis was so swollen it
took a very long time for it to heal ... We all learnt from him. Yes it happens that they cut
you in a bad way and they also stated this themselves and this would affect your whole life.
You cannot tell me that you do not have a penis and expect to have a wife and a home. You
will not be able to have a child for your whole life.

Contrary to Auvert’s bold claim, the men interviewed in our study argued that
because MC is only partially protective, it is useless to them as a means of individual
protection. Their major concern was that circumcised men are still required to use
condoms and therefore individual men could not see the value of circumcision, especially
given that male condoms are more efficacious in the prevention of HIV and other sexually
transmitted diseases (Pinkerton & Abramson, 1997). The logic of a public health benefit

You see Michael Jackson had all the money in the world but doctors messed him up and he
ended up looking like a doll. He tried to change how God had created him and at the end he
died and left all his money behind just because doctors could not fix him. Doctors know a bit
and God knows all so who are they to temper with what He has created?

we were told about ABC, which is being faithful, condomising ... hmm and abstaining. So I
think circumcising makes no sense with these things. Why circumcise if you abstain? Why
circumcise if you condomise? Why circumcise if you are faithful? They tell you to
circumcise and also use condoms, why? This thing is not 100% effective so why don’t you
just leave the circumcision thing and condomise?

Adolescents’ perceptions of MC
When compared to older men, younger men interviewed in this study seemed to favour
circumcision. Their perceptions about the procedure were mostly positive and they were
usually informed about MC at school during campaigns such as ‘MC Saturdays’ and the
Back-to-School Campaign. These campaigns specifically targeted pupils during school

You see this (MC) might be a way of increasing HIV prevalence. These people (foreign-led
implementation teams) know about MC and they have done a lot of research within it. They
know that if you are circumcised there will be reduced sensitivity and then you will be forced
not to use a condom and then after that you get AIDS. They know exactly about the effects
of MC. So when the sensitivity is lowered, they will not wear condoms that will further
reduce sensitivity and then not use it. So it is a way of increasing HIV or some form of
business. But also I think it is a way of decreasing the population.

Despite the negative attitude towards MC from older men, adolescents seem to be
more willing to utilise the intervention. This finding is also backed by the MC prevalence
figures. As we have stated above, more than 75% of all those who were circumcised since
the MC programme’s inception are males below the age of 20 (WHO, 2012). As more
than half of Swaziland’s population is below 18, this could mean that the country’s goals
of zero new HIV infections may be heavily influenced by adolescents’ positive
involvement in HIV mitigation programmes.