Circumcision, from the Mexican Immigrant Perspective  

We, at Sexualidades Latinas, recently found out that one of our colleagues is carrying out a study on the cultural factors associated with the acceptance of male circumcision as a method for HIV prevention among Mexican immigrants. Specifically, immigrants in San Francisco and those in Michoacán, Mexico who have spent time in the United States or have a partner who has spent time in the United States. A professor in the Department of Sexuality Studies at San Francisco State University, Héctor Carrillo is the principal investigator along with Ana Amuchastegui of Universidad Autónoma Metropolitana-Xochimilco.

Others on the study team are: Associate Investigators Rodrigo Parrini of CENSIDA México and Walter Gómez of the Center for Research on Gender and Sexuality; and collaborators Michael Díaz and Rachel Howard, master’s students in the Department of Sexuality Studies at San Francisco State University.

I had a chance to sit down and talk to the team. The following is the interview.

Alberto Rodriguez: Could you please describe the purpose of this project?

Ana Amuchastegui: To determine through qualitative research the possibility of circumcision being accepted as a method of HIV prevention among Mexican immigrant communities in the United States. We also want to develop an understanding of their knowledge of the procedure, what it means to them, and if they are aware that this could prevent HIV transmission. Also, to explore the cultural context this proposal would fit in, and how it is linked with their notions of body, genitals, and sexuality.

AR: How did you determine the need for this kind of study?

Rodrigo Parrini: It stemmed from the debates that were generated by the studies in Africa that revealed how circumcision can reduce the risk of HIV infection in heterosexual men in vaginal intercourse. It is considered by epidemiologists and physicians as a successful strategy for long-term prevention, especially in countries with highly extended epidemics such as Africa, with a prevalence of 15 percent.

However, it was in the Toronto conference where this [strategy was] planted at an international level and generated a great debate. In the case of Latin American . . . the secretaries of health want to see if this method can function or not, but there is not information.

Héctor Carrillo: We are focusing on the Mexican immigrant population. In San Francisco we are working with a group of immigrant men and women, among these there are couples, to whom we ask questions about their relationships. We are also interviewing medical personnel to have a better idea of how service providers relate to the subject. There is a similar sample we are carrying out in Michoacán, Mexico, which is the sample Ana and Rodrigo are working on.

AR: Who is an ideal candidate for the circumcision study?

Walter Gómez: In San Francisco our goal is to have twenty men and five women. We are recruiting people over eighteen years old, and they are required to have been born in Mexico. We're working with five staff members from a clinic that serves the Latin American community.

When we initially approach people they are concerned as to whether they have to be circumcised or not, but that does not affect their potential to participate in the study.

Héctor Carrillo: In fact we believe we will have many different types of [people] due to the differences that exist between the two samples: an urban immigrant population in San Francisco and mostly rural individuals in Michoacán.

AR: What are the methods you will use to obtain participation?

Rachel Howard: About two or three times a week we go to the clinic and visit the different rooms. We ask patients if they are interested in participating, tell them about the study, and we take their data.

Héctor Carrillo: We also have a phone number where people can call to express their interest and set up an appointment. However, the procedure is somewhat different in Mexico.

Rodrigo Parrini: In Mexico we recruited through healthcare centers. Michoacán is a very small city. The nurses of a health center have served as a liaison for us. There have not been any difficulties in the recruiting process. Men, women, and medical staffs have agreed to be interviewed.

AR: Have you had any difficulties recruiting candidates in San Francisco?

Michael Díaz: One of the main difficulties we have encountered in San Francisco is finding participants who were born in Mexico. Many times the people at the clinic are Honduran or El Salvadorian natives. In addition, people in the clinic are often sick or busy with their children and the last thing that want is to speak with a stranger on a topic that is completely unrelated to their personal health at the moment.

Walter Gómez: Aside from our active recruitment, we also perform passive recruitment, such as posting flyers throughout the healthcare facility. I believe that about half of the contacts we achieve are a result of this. People see the information and then decide to call us. This way, it is easier for them to work on their own time.

Ana Amuchastegui: The situation is quite different in San Francisco than in Mexico. The recruitment strategy in San Francisco is based on a greater distance and anonymity with the participants, given it is their decision if they come or not to the interview based on what they read on a flyer.

For our sample the nurse at the health center introduced us to the people she knew had migrated or whose husbands had done so. In our case, there was no resistance from the candidates to participate in the interviews.

However, they felt unwilling to discuss their sex life, bodies, sexual experiences . . . during a first encounter. Most people were willing to discuss the immigration experience, especially work scenarios, the suffering, the loneliness, and the mistreatment many face in the process.

AR: Have any of your participants been circumcised as an adult?

Ana Amuchastegui: In Mexico we don’t have any circumcised participants.

Walter Gómez: In San Francisco we came across an immigrant man whose son was born in the United States and the option given to him was not if the procedure should be performed on the child or not, but when it was to be carried out, now or later, when he would experience more pain. The power dynamics between an American physician and an immigrant patient proves to be very interesting. Another participant told me how he has considered [getting] the procedure as an adult.

Héctor Carrillo: It is worth mentioning that the rates of circumcision in adult Latin American men are very low. In general we will be dealing with adult men who have not been circumcised. Something we have observed in these initial interviews is the ignorance that surrounds this procedure; many people do not know what it entails. The result is intent to promote a practice that people don't seem to understand. This leads to a series of complications, especially of the cultural type.

AR : Is there a particular time frame you expect to complete the study?

Héctor Carrillo: We began the study simultaneously in both cities. We are expecting to conclude it in November 2009.

I would like to thank the circumcision study team for sharing the details of their investigation. I will check back with them later this year once the study is concluded.

Alberto Rodriguez currently edits the Sexualidades Latinas website for the National Sexuality Resource Center. He is also an MBA student at the San Francisco State University College of Business.