title: Barriers and motivators to voluntary medical male circumcision uptake among different age groups of men in Zimbabwe: results from a mixed methods study.
abstract: BACKGROUND
  We conducted quantitative and qualitative studies to explore barriers and motivating factors to VMMC for HIV prevention, and to assess utilization of existing VMMC communication channels.
  
  
  RESULTS
  A population-based survey was conducted with 2350 respondents aged 15-49. Analysis consisted of descriptive statistics and bivariate analysis between circumcision and selected demographics. Logistic regression was used to determine predictors of male circumcision uptake compared to intention to circumcise. Focus group discussions (FGDs) were held with men purposively selected to represent a range of ethnicities. 68% and 53% of female/male respondents, respectively, had heard about VMMC for HIV prevention, mostly through the radio (71%). Among male respondents, 11.3% reported being circumcised and 49% reported willingness to undergo VMMC. Factors which men reported motivated them to undergo VMMC included HIV/STI prevention (44%), improved hygiene (26%), enhanced sexual performance (6%) and cervical cancer prevention for partner (6%). Factors that deterred men from undergoing VMMC included fear of pain (40%), not believing that they were at risk of HIV (18%), lack of partner support (6%). Additionally, there were differences in motivators and barriers by age. FGDs suggested additional barriers including fear of HIV testing, partner refusal, reluctance to abstain from sex and myths and misconceptions.
  
  
  CONCLUSIONS
  VMMC demand-creation messages need to be specifically tailored for different ages and should emphasize non-HIV prevention benefits, such as improved hygiene and sexual appeal, and need to address men's fear of pain. Promoting VMMC among women is crucial as they appear to have considerable influence over men's decision to get circumcised.
authors.affiliation: Population Services International, Harare, Zimbabwe.
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.affiliation: Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe; Centre for Sexual Health & HIV Research, University College London, London, United Kingdom.
authors.forename: Webster
authors.initials: W
authors.lastname: Mavhu
authors.affiliation: Population Services International, Harare, Zimbabwe.
authors.forename: Phineas
authors.initials: P
authors.lastname: Jasi
authors.affiliation: Population Services International, Harare, Zimbabwe.
authors.forename: Kumbirai
authors.initials: K
authors.lastname: Chatora
authors.affiliation: Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe; Centre for Sexual Health & HIV Research, University College London, London, United Kingdom.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.affiliation: Population Services International, Washington, District of Columbia, United States of America.
authors.forename: Noah
authors.initials: N
authors.lastname: Taruberekera
authors.affiliation: Ministry of Health and Child Welfare, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: United States Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Kim
authors.initials: K
authors.lastname: Ahanda
authors.affiliation: United States Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002944:Circumcision, Male / Q000193:education / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D015030:Zimbabwe