Abstract
BackgroundIn many communities, older men (i.e., over 25 years of age) have not come forward for Voluntary Medical Male Circumcision (VMMC) services. Reasons for low demand among this group of men are not well understood, and may vary across geographic and cultural contexts. This paper examines the facilitators and barriers to VMMC demand in Turkana County, Kenya, with a focus on older men. This is one of the regions targeted by the VMMC program in Kenya because the Turkana ethnic group does not traditionally circumcise, and the rates of HIV and STD transmission are high.Methods and FindingsTwenty focus group discussions and 69 in-depth interviews were conducted with circumcised and uncircumcised men and their partners to elicit their attitudes and perceptions toward male circumcision. The interviews were conducted in urban, peri-urban, and rural communities across Turkana. Our results show that barriers to circumcision include stigma associated with VMMC, the perception of low risk for HIV for older men and their “protection by marriage,” cultural norms, and a lack of health infrastructure. Facilitators include stigma against not being circumcised (since circumcision is associated with modernity), protection against disease including HIV, and cleanliness. It was also noted that older men should adopt the practice to serve as role models to younger men.ConclusionsBoth men and women were generally supportive of VMMC, but overcoming barriers with appropriate communication messages and high quality services will be challenging. The justification of circumcision being a biomedical procedure for protection against HIV will be the most important message for any communication strategy.
Highlights
Voluntary medical male circumcision (VMMC) is a biomedical intervention with proven efficacy in reducing HIV transmission [1,2,3,4]
Both men and women were generally supportive of Voluntary Medical Male Circumcision (VMMC), but overcoming barriers with appropriate communication messages and high quality services will be challenging
The potential impact of VMMC is immense: if 80% coverage is achieved among males 15–49 years in 13 countries of Eastern and Southern Africa by 2025, nearly 4 million infections could be averted [5,6]
Summary
Voluntary medical male circumcision (VMMC) is a biomedical intervention with proven efficacy in reducing HIV transmission [1,2,3,4]. The potential impact of VMMC is immense: if 80% coverage is achieved among males 15–49 years in 13 countries of Eastern and Southern Africa by 2025, nearly 4 million infections could be averted [5,6]. Ability to meet this goal is limited by two challenges: scalability of services and client demand. Initial VMMC roll-out attracted mostly boys and men under 25, yet men between 25 and 50 have higher rates of HIV infection and need the protection of circumcision as much as the younger generation Increasing demand among these older clients is a priority in many settings [13]. This is one of the regions targeted by the VMMC program in Kenya because the Turkana ethnic group does not traditionally circumcise, and the rates of HIV and STD transmission are high
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