Background: HIV prevalence is high (20.9%) in South Africa among men aged 25-49 years. Medical male circumcision (MMC) reduces the risk of HIV infection in men from heterosexual sex. Few studies have assessed women''s role in promoting MMC. Baseline qualitative data are summarised from a study conducted in a peri-urban setting in Ekurhuleni North, South Africa from April - September 2014 that aimed to increase MMC uptake among older men.
Methods: Adult men (25-49 years) and women (≥18 years) were interviewed in English, Sepedi or Zulu. Interviews were digitally-recorded, transcribed, and translated. Through a standard iterative process, a codebook was developed for each sex and used to thematically code the interviews using MAXQDA 10 (males) and QSR NVIVO 10 (females). Inductive thematic analysis was used. Descriptive statistics were calculated.
Results: A total of 35 men and 30 women were interviewed. Men described women as better communicators than men and better equipped to discuss MMC. Some men felt that it is helpful for female sexual partners to recommend MMC for shy men, and most agreed that men would be more likely to pursue MMC if women introduced it. A minority of men felt that women promoting MMC means that the man is weak and an embarrassment. Women felt that they should use indirect methods of introducing the topic of MMC with their partner, which could include mentioning a magazine article, newspaper report, pamphlet, or media advert while talking to him in a respectful and calm manner. Women emphasized being patient and the use of different opportunities to direct his attention to available MMC information. Some women were also concerned that discussing the topic of MMC with their partners might make them suspicious about their fidelity. Women also perceived educated females as being less constrained when talking about MMC to their partners when compared to those who followed exclusive traditional roles.
Conclusions: Innovative approaches to demand creation to increase MMC uptake among men aged 25-49 years are especially important given the high HIV prevalence and low MMC uptake in this age group. Men and women are largely supportive of women promoting MMC.

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