DRAFT: DO NOT CITE WITHOUT AUTHOR PERMISSION Contemplating Circumcision for HIV Prevention in a Low-Uptake Environment Rachael S. Pierotti, University of Michigan Rebecca Thornton,∗ University of Michigan Paper prepared for presentation at the annual meetings of the Population Association of America, San Francisco, California, May 2012. Abstract: This paper presents evidence from 64 in-depth interviews with a sample of urban men who participated in a quantitative study of prospects for increasing medical male circumcision for HIV prevention in Malawi. Despite genuine interest in circumcision, stumbling blocks in the decision-making process deterred men from undergoing the surgery. The high cost of circumcision, including time off from income generation during the recovery period, forced men to choose between circumcision and other responsibilities. Men were often hesitant to give high priority to circumcision because of fear of the surgery. Moreover, men had limited access to accurate information on medical circumcision, which they could have used to allay their fears. Finally, inadequate service provision meant that some men who attempted to get circumcised were turned away by the clinic. Many of these barriers in the decision-making process were especially problematic because medical male circumcision is relatively rare in Malawi. ∗ Corresponding author: Department of Economics, University of Michigan, 213 Lorch Hall, 611 Tappan St. Ann Arbor MI, 48109-1220, USA;
[email protected]; Funding for this study was provided by 3ie. One of the authors was supported by the National Science Foundation Graduate Research Fellowship [Grant No. DGE 0718128]. We are grateful for the hard work and cooperation of BLM and especially Brendan Hayes.