TY - JOUR
T1 - Impact of Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision on Knowledge and Sexual Intentions
AU - Kaufman, Michelle R.
AU - Patel, Eshan U.
AU - Dam, Kim H.
AU - Packman, Zoe R.
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 USAID with PEPFAR funding (cooperative agreement number AID-OAA-A-12-00058) to the Johns Hopkins Center for Communication Programs and co-funded 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. Little is known regarding the impact of counseling delivered during voluntary medical male circumcision (VMMC) services on adolescents' human immunodeficiency virus (HIV) knowledge, VMMC knowledge, or post-VMMC preventive sexual intentions. This study assessed the effect of counseling on knowledge and intentions. Methods. Surveys were conducted with 1293 adolescent clients in 3 countries (South Africa, n = 299; Tanzania, n = 498; Zimbabwe, n = 496). Adolescents were assessed on HIV and VMMC knowledge-based items before receiving VMMC preprocedure counseling and at a follow-up survey approximately 10 days postprocedure. Sexually active adolescents were asked about their sexual intentions in the follow-up survey. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated by modified Poisson regression models with generalized estimating equations and robust variance estimators. Results. Regarding post-VMMC HIV prevention knowledge, older adolescents were significantly more likely than younger adolescents to know that a male should use condoms (age 10-14 years, 41.1%; 15-19 years, 84.2%; aPR, 1.38 [95% CI, 1.19-1.60]), have fewer sex partners (age 10-14 years, 8.1%; age 15-19 years, 24.5%; aPR, 2.10 [95% CI, 1.30-3.39]), and be faithful to one partner (age 10-14 years, 5.7%; age 15-19 years, 23.2%; aPR, 2.79 [95% CI, 1.97-3.97]) to further protect himself from HIV. Older adolescents demonstrated greater improvement in knowledge in most categories, differences that were significant for questions regarding number of sex partners (aPR, 2.01 [95% CI, 1.18-3.44]) and faithfulness to one partner post-VMMC (aPR, 3.28 [95% CI, 2.22-4.86]). However, prevention knowledge levels overall and HIV risk reduction sexual intentions among sexually active adolescents were notably low, especially given that adolescents had been counseled only 7-10 days prior. Conclusions. Adolescent VMMC counseling needs to be improved to increase knowledge and postprocedure preventive sexual intentions.
AB - Background. Little is known regarding the impact of counseling delivered during voluntary medical male circumcision (VMMC) services on adolescents' human immunodeficiency virus (HIV) knowledge, VMMC knowledge, or post-VMMC preventive sexual intentions. This study assessed the effect of counseling on knowledge and intentions. Methods. Surveys were conducted with 1293 adolescent clients in 3 countries (South Africa, n = 299; Tanzania, n = 498; Zimbabwe, n = 496). Adolescents were assessed on HIV and VMMC knowledge-based items before receiving VMMC preprocedure counseling and at a follow-up survey approximately 10 days postprocedure. Sexually active adolescents were asked about their sexual intentions in the follow-up survey. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated by modified Poisson regression models with generalized estimating equations and robust variance estimators. Results. Regarding post-VMMC HIV prevention knowledge, older adolescents were significantly more likely than younger adolescents to know that a male should use condoms (age 10-14 years, 41.1%; 15-19 years, 84.2%; aPR, 1.38 [95% CI, 1.19-1.60]), have fewer sex partners (age 10-14 years, 8.1%; age 15-19 years, 24.5%; aPR, 2.10 [95% CI, 1.30-3.39]), and be faithful to one partner (age 10-14 years, 5.7%; age 15-19 years, 23.2%; aPR, 2.79 [95% CI, 1.97-3.97]) to further protect himself from HIV. Older adolescents demonstrated greater improvement in knowledge in most categories, differences that were significant for questions regarding number of sex partners (aPR, 2.01 [95% CI, 1.18-3.44]) and faithfulness to one partner post-VMMC (aPR, 3.28 [95% CI, 2.22-4.86]). However, prevention knowledge levels overall and HIV risk reduction sexual intentions among sexually active adolescents were notably low, especially given that adolescents had been counseled only 7-10 days prior. Conclusions. Adolescent VMMC counseling needs to be improved to increase knowledge and postprocedure preventive sexual intentions.
KW - HIV counseling
KW - HIV prevention
KW - adolescents
KW - sub-Saharan Africa
KW - voluntary medical male circumcision
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U2 - 10.1093/cid/cix973
DO - 10.1093/cid/cix973
M3 - Article
C2 - 29617781
AN - SCOPUS:85045448948
SN - 1058-4838
VL - 66
SP - S221-S228
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -