Stronger or tougher: reasons for penile cutting in Papua New Guinea

Background: Papua New Guinea is a diverse country with a population of 6.8 million people speaking more than 800 languages. PNG has more than 90% of all reported cases of HIV in Oceania. Following trials that showed male circumcision reduces the risk of heterosexual men acquiring HIV, MC is now recommended in comprehensive HIV prevention packages for populations with a heterosexual, generalised epidemic and where most men are not circumcised. The 'Acceptability and Feasibility of Male Circumcision for HIV Prevention in PNG' study documented reasons for penile cutting in four locations across PNG. Methods: Both men and women completed structured questionnaires about penile cutting. Sites were two university campuses in large urban centres, a remote mountain gold mine and coastal oil palm plantation. These are locations where people from across the country gather for work or study. The questionnaire included specific questions on the reasons for penile cutting. Results: 864 males and 560 females completed questionnaires. 57% of males reported some form of penile cutting. Reasons reported by men were both historical and contemporary: being a part of custom/tradition; cleanliness; peer influence; to increase the size of the penis; avoid STI; increase sexual pleasure; prolong sexual intercourse; perceived increase in female sexual pleasure. Conclusion: There was a diverse range of reasons for penile cutting reported in this study population. Any potential male circumcision for HIV prevention programs in Papua New Guinea need to take into account the wide range of traditional and contemporary penile cutting practices, and the reasons these cuts are being done.