TY - JOUR
T1 - Age Differences in Perceptions of and Motivations for Voluntary Medical Male Circumcision among Adolescents in South Africa, Tanzania, and Zimbabwe
AU - Patel, Eshan U.
AU - Kaufman, Michelle R.
AU - Dam, Kim H.
AU - Van Lith, Lynn M.
AU - Hatzold, Karin
AU - Marcell, Arik V.
AU - Mavhu, Webster
AU - Kahabuka, Catherine
AU - Mahlasela, Lusanda
AU - Njeuhmeli, Emmanuel
AU - Ahanda, Kim Seifert
AU - Ncube, Getrude
AU - Lija, Gissenge
AU - Bonnecwe, Collen
AU - Tobian, Aaron A.R.
N1 - Funding Information:
Financial support. This work was supported by the United States Agency for International Development with PEPFAR funding (cooperative agreement AID-OAA-A-12-00058) to the Johns Hopkins Center for Communication Programs and cofunded by the UK Department of International Development through the Integrated Support Program in Zimbabwe.
Publisher Copyright:
© 2018 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2018/4/3
Y1 - 2018/4/3
N2 - Background. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have set a Fast-Track goal to achieve 90% coverage of voluntary medical male circumcision (VMMC) among boys and men aged 10-29 years in priority settings by 2021. We aimed to identify age-specific facilitators of VMMC uptake among adolescents. Methods. Younger (aged 10-14 years; n = 967) and older (aged 15-19 years; n = 559) male adolescents completed structured interviews about perceptions of and motivations for VMMC before receiving VMMC counseling at 14 service provision sites across South Africa, Tanzania, and Zimbabwe. Adjusted prevalence ratios (aPRs) were estimated using multivariable modified Poisson regression models with generalized estimating equations and robust standard errors. Results. The majority of adolescents reported a strong desire for VMMC. Compared with older adolescents, younger adolescents were less likely to cite protection against human immunodeficiency virus (HIV) or other sexually transmitted infections (aPR, 0.77; 95% confidence interval [CI],.66-.91) and hygienic reasons (aPR, 0.55; 95% CI,.39-.77) as their motivation to undergo VMMC but were more likely to report being motivated by advice from others (aPR, 1.88; 95% CI, 1.54-2.29). Although most adolescents believed that undergoing VMMC was a normative behavior, younger adolescents were less likely to perceive higher descriptive norms (aPR, 0.79;.71-.89), injunctive norms (aPR, 0.86; 95% CI,.73-1.00), or anticipated stigma for being uncircumcised (aPR, 0.79; 95% CI,.68-.90). Younger adolescents were also less likely than older adolescents to correctly cite that VMMC offers men and boys partial HIV protection (aPR, 0.73; 95% CI,.65-.82). Irrespective of age, adolescents' main concern about undergoing VMMC was pain (aPR, 0.95; 95% CI,.87-1.04). Among younger adolescents, fear of pain was negatively associated with desire for VMMC (aPR, 0.89; 95% CI,.83-.96). Conclusions. Age-specific strategies are important to consider to generate sustainable demand for VMMC. Programmatic efforts should consider building on the social norms surrounding VMMC and aim to alleviate fears about pain.
AB - Background. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have set a Fast-Track goal to achieve 90% coverage of voluntary medical male circumcision (VMMC) among boys and men aged 10-29 years in priority settings by 2021. We aimed to identify age-specific facilitators of VMMC uptake among adolescents. Methods. Younger (aged 10-14 years; n = 967) and older (aged 15-19 years; n = 559) male adolescents completed structured interviews about perceptions of and motivations for VMMC before receiving VMMC counseling at 14 service provision sites across South Africa, Tanzania, and Zimbabwe. Adjusted prevalence ratios (aPRs) were estimated using multivariable modified Poisson regression models with generalized estimating equations and robust standard errors. Results. The majority of adolescents reported a strong desire for VMMC. Compared with older adolescents, younger adolescents were less likely to cite protection against human immunodeficiency virus (HIV) or other sexually transmitted infections (aPR, 0.77; 95% confidence interval [CI],.66-.91) and hygienic reasons (aPR, 0.55; 95% CI,.39-.77) as their motivation to undergo VMMC but were more likely to report being motivated by advice from others (aPR, 1.88; 95% CI, 1.54-2.29). Although most adolescents believed that undergoing VMMC was a normative behavior, younger adolescents were less likely to perceive higher descriptive norms (aPR, 0.79;.71-.89), injunctive norms (aPR, 0.86; 95% CI,.73-1.00), or anticipated stigma for being uncircumcised (aPR, 0.79; 95% CI,.68-.90). Younger adolescents were also less likely than older adolescents to correctly cite that VMMC offers men and boys partial HIV protection (aPR, 0.73; 95% CI,.65-.82). Irrespective of age, adolescents' main concern about undergoing VMMC was pain (aPR, 0.95; 95% CI,.87-1.04). Among younger adolescents, fear of pain was negatively associated with desire for VMMC (aPR, 0.89; 95% CI,.83-.96). Conclusions. Age-specific strategies are important to consider to generate sustainable demand for VMMC. Programmatic efforts should consider building on the social norms surrounding VMMC and aim to alleviate fears about pain.
KW - HIV
KW - adolescent health
KW - male circumcision
KW - motivation
KW - norms
KW - stigma
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U2 - 10.1093/cid/cix951
DO - 10.1093/cid/cix951
M3 - Article
C2 - 29617775
AN - SCOPUS:85045432213
SN - 1058-4838
VL - 66
SP - S173-S182
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -