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Doubt, defiance, and identity: understanding resistance to male circumcision for HIV prevention in Malawi

Parkhurst, Justin, Chilongozi, David and Hutchinson, Eleanor (2015) Doubt, defiance, and identity: understanding resistance to male circumcision for HIV prevention in Malawi. Social Science and Medicine, 135. pp. 15-22. ISSN 0277-9536

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Identification Number: 10.1016/j.socscimed.2015.04.020

Abstract

Global policy recommendations to scale up of male circumcision (MC) for HIV prevention tend to frame the procedure as a simple and efficacious public health intervention. However, there has been variable uptake of MC in countries with significant HIV epidemics. Kenya, for example, has embraced MC and has been dubbed a ‘leader’ by the global health community, while Malawi has been branded a ‘laggard’ in its slow adoption of a national programme, with a strong political discourse of resistance forming around MC. Regardless of any epidemiological or technical evidence, the uptake of international recommendations will be shaped by how a policy, and the specific artefacts that constitute that policy, intersect with local concerns. MC holds particular significance within many ethnic and religious groups, serving as an important rite of passage, but also designating otherness or enabling the identification of the social and political self. Understanding how the artefact of MC intersects with local social, economic, and political contexts, is therefore essential to understand the acceptance or resistance of global policy recommendations. In this paper we present an in-depth analysis of Malawi's political resistance to MC, finding that ethnic and religious divisions dominating recent political movements aligned well with differing circumcision practices. Political resistance was further found to manifest through two key narratives: a ‘narrative of defiance’ around the need to resist donor manipulation, and a ‘narrative of doubt’ which seized on a piece of epidemiological evidence to refute global claims of efficacy. Further, we found that discussions over MC served as an additional arena through which ethnic identities and claims to power could themselves be negotiated, and therefore used to support claims of political legitimacy.

Item Type: Article
Official URL: https://www.sciencedirect.com/journal/social-scien...
Additional Information: © 2015 The Authors
Divisions: Health Policy
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Health Policy
Date Deposited: 05 Jul 2018 14:18
Last Modified: 20 Jun 2019 02:09
Projects: 282118
Funders: European Research Council
URI: http://eprints.lse.ac.uk/id/eprint/89073

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