Abstract
Male circumcision (MC) reduces HIV acquisition among men, leading WHO/UNAIDS to recommend a goal to circumcise 80 % of men in high HIV prevalence countries. Significant investment to increase MC capacity in priority countries was made, yet only 5 % of the goal has been achieved in Zimbabwe. The integrated behavioral model (IBM) was used as a framework to investigate the factors affecting MC motivation among men in Zimbabwe. A survey instrument was designed based on elicitation study results, and administered to a representative household-based sample of 1,201 men aged 18–30 from two urban and two rural areas in Zimbabwe. Multiple regression analysis found all five IBM constructs significantly explained MC Intention. Nearly all beliefs underlying the IBM constructs were significantly correlated with MC Intention. Stepwise regression analysis of beliefs underlying each construct respectively found that 13 behavioral beliefs, 5 normative beliefs, 4 descriptive norm beliefs, 6 efficacy beliefs, and 10 control beliefs were significant in explaining MC Intention. A final stepwise regression of the five sets of significant IBM construct beliefs identified 14 key beliefs that best explain Intention. Similar analyses were carried out with subgroups of men by urban–rural and age. Different sets of behavioral, normative, efficacy, and control beliefs were significant for each sub-group, suggesting communication messages need to be targeted to be most effective for sub-groups. Implications for the design of effective MC demand creation messages are discussed. This study demonstrates the application of theory-driven research to identify evidence-based targets for intervention messages to increase men’s motivation to get circumcised and thereby improve demand for male circumcision.
Highlights
Adult male circumcision (MC) has been demonstrated to reduce HIV incidence among men by up to 60 % [1,2,3,4]
Male circumcision (MC) programs in Sub-Saharan Africa have been in the implementation phase since 2007 and much of the focus of these programs has been on supply-side strategies with the expansion of MC capacity
Quantitative and qualitative studies in Kenya [46, 47], South Africa [48, 49], Zambia [50], Zimbabwe [51, 52] and Botswana [53] suggested MC would be acceptable, provided that the role of MC in HIV prevention was made clear to participants
Summary
Adult male circumcision (MC) has been demonstrated to reduce HIV incidence among men by up to 60 % [1,2,3,4]. MC offers significant protection from other sexually transmitted infections [5,6,7]. The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS recommended that MC programs be included as part of the overall HIV prevention strategy in countries where HIV is primarily transmitted heterosexually, and MC prevalence is low [8]. WHO coordinated the development of models to optimize the volume and efficiency (MOVE) of MC services. Key features of these models included task shifting, expanded use of less specialized clinicians to perform routine tasks, and bundling of commodities for MC procedures [20, 21]. Despite the significant investment in MC capacity improvements, as of the end of 2012 ten priority countries had achieved less than 20 % of the 2015 targets, and five priority countries where MC is stated to be a priority had reached less than 10 % of their targets [22]
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