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Studying the Impacts of Medical Male Circumcision on Traditional Beliefs

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Studying the Impacts of Medical Male Circumcision on Traditional Beliefs View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Research Repository Negotiating Change: Studying the Impacts of Medical Male Circumcision on Traditional Beliefs in Western Kenya Margaret Kabare Thesis submitted for the degree of Doctor of Philosophy, Murdoch University, 2019 DECLARATION I declare that this thesis is my own account of my research and contains as its main content work which has not previously been submitted for a degree at any tertiary education institution. Margaret Kabare ii ABSTRACT Medical male circumcision (MMC) was introduced in various sub-Saharan African countries from 2007 as a biomedical intervention for HIV prevention. The introduction of MMC for HIV prevention has occurred at a time when African societies are experiencing rapid transformations in the face of modernisation and globalization. Combined, the processes of modernisation and globalization are altering how individuals engage with traditions. Among the areas where striking changes have occurred is health. Various scholars have drawn attention to the ongoing intensification of medicalization and public health interventions premised on the modern notion of rational decision-making individuals, although the complexity of how these changes interact with traditional and localized contexts is not well understood. With a focus on the Kenyan context, this mixed-method, multi-sited study explores the extent to which medical male circumcision impacts on traditional ideas, beliefs, and behaviours and vice versa. The study draws on perspectives about male circumcision (MC) in a region where some ethnic groups practice MC as a cultural tradition while others do not, and where MMC is now promoted as an intervention for HIV prevention. Through a mixed-methods process of data collection and analysis, four broad themes emerged: the construction of new, modern identities via traditional ideas as driving the uptake of the intervention; the disruption of traditional practices and ideas and the emergence of identity crises; the construction of biomedical knowledge in ways that both potentiate and suppress the uptake of the intervention in contemporary settings; and the persistence of traditional ideas and practices which generally impede the spread of biomedical innovations. The study concludes that within the Kenyan context, the adoption of a modern, biomedical intervention has had significant impacts on the beneficiaries, with several of these impacts being unintended. The meanings attached to MC reflect both the traditional and the modern in complex ways linked to changing socio-political contexts (both micro and macro) and varied rationalities, underlining the way that the dissemination of modern, biomedical knowledge is heavily contextualized. iii ACKNOWLEDGEMENTS The completion of this thesis is a reality because of the support I received from a large “community”. Firstly, I offer my deepest gratitude to my principal supervisor, Dr. Jeremy Northcote for accepting me as a PhD student, his unwavering support of my research and guidance throughout my candidature. I am also indebted to co-supervisor Dr. Joshua Aleri who despite coming on board in the later stages of my candidature, always created time to help me with my analyses, provided insightful comments on previous drafts, and went over and beyond in his support to ensure I completed writing this thesis. I am extremely grateful to Dr. Dickens Omondi, my academic advisor in Kenya whose feedback on my early drafts went a long way in helping me clarify my thinking process-asante sana daktari for your mentorship and a big thank you to your family for graciously having me in your home on many occasions during my fieldwork. Through its International Research Scholarship, Murdoch University provided the financial support necessary for the completion of this research and for that I am truly grateful. To my research participants who welcomed me into their community and willingly participated in this study, I say thank you. I am thankful to my friends in Perth and at Murdoch University for their support and those in Kenya who stayed in touch and wished me well. Special thanks to Julie, Edith and George for their steadfast friendship, Yohanna for the many sisterhood moments, Walter for generously offering his time and skills when I had all sorts of technical emergencies and the entire “connect gang” for their encouragement and kindness. Finally, I wish to express my appreciation to my family. This thesis is dedicated to my mum, Alice and my late dad, Rev. Fred Kabare. No words are enough to convey my gratitude to my parents who made so many sacrifices to educate my siblings and I despite not having much education themselves– Mum and Dad, this is for you. To my siblings David, Esther, Miriam, Dan, and Lucy – thank you always for your love and support. I cannot forget to thank my nephews and nieces – Leshan, Natasha, Faith, and Joy (and baby Reign who I am yet to meet!) who checked up on me often and motivated me to live up to their expectations. iv TABLE OF CONTENTS DECLARATION ............................................................................................................................. ii ABSTRACT .................................................................................................................................... iii ACKNOWLEDGEMENTS ............................................................................................................ iv TABLE OF CONTENTS ................................................................................................................. v LIST OF TABLES AND FIGURES ............................................................................................... ix ABBREVIATIONS ......................................................................................................................... x CHAPTER ONE: INTRODUCTION ............................................................................................ 11 1.1 Introduction .......................................................................................................................... 11 1.2 Background .......................................................................................................................... 11 1.3 Study significance ................................................................................................................ 20 1.4 Research objectives .............................................................................................................. 22 1.5 Thesis structure .................................................................................................................... 23 CHAPTER TWO: METHODOLOGY .......................................................................................... 27 2.1 Introduction .......................................................................................................................... 27 2.2 Research approach ............................................................................................................... 27 2.2.1 Multi-site case-study approach ..................................................................................... 27 2.2.2 Mixed-methods research design .................................................................................... 30 v 2.3 Data collection ..................................................................................................................... 37 2.4 Reflexivity ........................................................................................................................... 44 2.5 Textual data management and analysis ................................................................................ 46 2.6 Conclusion ........................................................................................................................... 47 CHAPTER THREE: LITERATURE REVIEW ............................................................................ 48 CHAPTER FOUR: HIV/AIDS ...................................................................................................... 69 4.1 Introduction .......................................................................................................................... 69 4.2 HIV/AIDS: Overview .......................................................................................................... 69 4.2.1 Section I: Factors contributing to high HIV rates in Eastern and Southern Africa ....... 72 4.2.2 Section II: HIV prevention interventions ...................................................................... 83 4.2.3 Section III: Medical male circumcision for HIV prevention ........................................ 89 4.3 Conclusion ......................................................................................................................... 100 CHAPTER FIVE: RESULTS FROM THE HOUSEHOLD SURVEY ....................................... 101 5.1 Introduction ........................................................................................................................ 101 5.2 Results ................................................................................................................................ 102 5.3 Discussion .......................................................................................................................... 121 5.6 Conclusion ......................................................................................................................... 124
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