ethnicity and opinions on male circumcision, newly/finally published research

Last month a paper I wrote with Michelle Poulin, “Ethnic identity, region and attitudes towards male circumcision in a high HIV-prevalence country”, was published in Global Public Health: An International Journal for Research, Policy and Practice. Though the title probably reads a bit specific and perhaps as even uninteresting, the paper’s findings are somewhat controversial — controversial because we show evidence of a potential problem for male circumcision as HIV prevention tool. We find that ethnic identity can shape how one views male circumcision. More specifically, the data show that people from ethnic groups that don’t typically practice male circumcision have negative opinions toward circumcision.

Here is the paper’s abstract (forgive the British English–GPH is published in the UK):

We study how considerations of male circumcision (MC) as both a favourable practice and as protective against HIV are linked with ethnicity in sub-Saharan Africa, where many ethnic groups do not traditionally circumcise. We focus on Malawi, a country with a high HIV prevalence but low MC prevalence. Survey data from a population-based random sample in rural Malawi (N =3400) were analysed for ethnoregional patterns in attitudes towards MC. We used logit regression models to measure how reported circumcision status, region of residence and ethnic identity relate to attitudes towards circumcision. Overall, Malawians reported more negative than positive opinions about MC, but attitudes towards circumcision varied by ethnicity and region. The implications for agencies and governments aggressively scaling up the provision of MC are clear; acceptance of circumcision as a tool for HIV prevention could be low in societies divided by ethnoregional identities that also shape the practice of circumcision.

This paper was rejected by seven different journals before we sent it to GPH. I have not learned to love rejection, but I have learned to pick up the pieces and move on. In the case of this paper, we took what little feedback we received and try to improve the manuscript.

There was some feedback, however, that I didn’t quite know what to do with. At a journal not-to-be-named, we received two positive reviews from reviewers, and a long list of problems with the manuscript from the editorial board, which ended with:

The paper is authored by two experts from Texas, none from Malawi. A Malawian co-author would have provided valuable insights not otherwise obtainable.

Has anyone else ever received something like that in a review?