title: Attitudes, perceptions and potential uptake of male circumcision among older men in Turkana County, Kenya using qualitative methods.
abstract: BACKGROUND
  In 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.
  
  
  RESULTS
  Twenty 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.
  
  
  CONCLUSIONS
  Both 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.
authors.affiliation: Aidspan, Nairobi, Kenya; Department of Global Health Systems and Development, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Kate
authors.initials: K
authors.lastname: Macintyre
authors.affiliation: Department of Global Health Systems and Development, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Katherine
authors.initials: K
authors.lastname: Andrinopoulos
authors.affiliation: Oxfam-GB, Lodwar, Kenya.
authors.forename: Natome
authors.initials: N
authors.lastname: Moses
authors.affiliation: Learning for Action, San Francisco, California, United States of America.
authors.forename: Marta
authors.initials: M
authors.lastname: Bornstein
authors.affiliation: National AIDS and STD Control Programme, Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Athanasius
authors.initials: A
authors.lastname: Ochieng
authors.affiliation: Department of Global Health Systems and Development, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Erin
authors.initials: E
authors.lastname: Peacock
authors.affiliation: Department of Global Health Systems and Development, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Jane
authors.initials: J
authors.lastname: Bertrand
mesh_terms: D000328:Adult; D000367:Age Factors; D002944:Circumcision, Male / Q000193:education / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged