1. What women think about male circumcision: Perceptions of the female partners of recently circumcised men in Nyanza Province, Kenya Timothy Okeyo 1, Nelli Westercamp 2, Robert C. Bailey 2, Kawango Agot 3, Walter Jaoko 4 1 Nyanza Reproductive Health Society, Kenya 2 University of Illinois at Chicago, USA 3 Impact Research and Development Organization, Kenya 4 University of Nairobi, Kenya

2. Background As safe, voluntary medical male circumcision (VMMC) services are scaled up, it is imperative to: –Involve women in the circumcision decision process –Educate women about risks and benefits of the procedure –Assess the impact of male circumcision on womens sexual health, attitudes and behavior Study Objective –Examine perceptions about circumcision among female partners of recently circumcised men Part of a larger observational study evaluating behavioral risk compensation following male circumcision in Western Kenya.

3. Study Design 18-35 year old men seeking circumcision services were recruited from 8 governmental health facilities Men were asked to refer their long term female partners Female partners eligibility: –18 years old –In the relationship with the referring man before and after his circumcision Men and women interviewed separately Questions on key perceptions and beliefs asked of males and females Data analyzed on individual and couple (McNemar test) levels

4. Sample description This analysis is based on 101 female partners of newly circumcised men and their partners FemalesMales Median age2122 Ethnicity: Luo88%99% Employed45%57%

5. Satisfaction with the procedure of women were very or somewhat satisfied with the way their partners circumcision procedure was carried out (1.5% were somewhat dissatisfied, 1.5% had no opinion) 97% of women were very or somewhat satisfied with the appearance of their partners penis after circumcision (1.3% were somewhat dissatisfied, 2.7% had no opinion) 96% 100% of women were pleased that partner went for male circumcision

6. Sexual satisfaction of women enjoyed sex more after partner's circumcision (4% found sex more enjoyable before partners circumcision, 5% found no difference) 91% 100% of women were satisfied with partner's sexual performance after MC

7. Facilitators of MC

8. Potential barriers to MC

9. Risk perception of women believed they have no chance or small chance of becoming infected with HIV (66% of male partners held the same belief) 84% of self-perceived low risk women stated that circumcision status of their partner was one of the explanations for their perception of low HIV risk 38% of women felt more protected against sexually transmitted diseases after their partners circumcision (92% of men held the same belief) 88%

10. Beliefs about male circumcision

11. Perception of change in risk Now that MC is available…

12. Conclusions Women had favorable attitudes towards male circumcision Women perceived themselves to be more protected from HIV/STI following their partners circumcision and were more likely to be willing to engage in risk compensating behaviours Educational messages about partial protection of male circumcision targeting women are necessary

13. Limitations Small sample size Difficulty recruiting female partners Limited generalizability Cross-sectional design for female partners sample

14. Acknowledgements We are grateful to all study participants, research assistants, and the NRHS staff for making this study a success Kenyan Government FHI, EngenderHealth, and the University of Illinois at Chicago, working with the Nyanza Reproductive Health Society, are partners in the Consortium, which is funded by a grant to FHI from the Bill & Melinda Gates Foundation