title: Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa.
abstract: Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO, South Africa has embarked on an ambitious VMMC programme. However, South Africa still falls short of meeting VMMC targets, particularly in KwaZulu-Natal, the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection, led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas), which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial, as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction, as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys.
authors.affiliation: a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Gavin
authors.initials: G
authors.lastname: George
authors.forename: Michael
authors.initials: M
authors.lastname: Strauss
authors.forename: Petronella
authors.initials: P
authors.lastname: Chirawu
authors.forename: Bruce
authors.initials: B
authors.lastname: Rhodes
authors.forename: Janet
authors.initials: J
authors.lastname: Frohlich
authors.forename: Carl
authors.initials: C
authors.lastname: Montague
authors.forename: Kaymarlin
authors.initials: K
authors.lastname: Govender
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002944:Circumcision, Male / Q000208:ethnology / Q000523:psychology*; D003469:Culture; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D057226:Information Seeking Behavior; D008297:Male; D009313:National Health Programs; D015995:Prevalence; D036301:Qualitative Research; D012725:Sexual Behavior; D012931:Social Environment; D013019:South Africa / Q000453:epidemiology; D035141:Voluntary Programs; D055815:Young Adult
keywords: HIV; South Africa; VMMC; adolescents; demand creation