title: Stages of Change for Voluntary Medical Male Circumcision and Sexual Risk Behavior in Uncircumcised Zambian Men: The Spear and Shield Project.
abstract: BACKGROUND
  Dissemination and scale up of voluntary medical male circumcision (VMMC) programs is well supported by evidence that VMMC reduces HIV risk in populations with high HIV prevalence and low rates of circumcision, as is the case in Zambia.
  
  
  OBJECTIVE
  At both individual and population levels, it is important to understand what stages of change for VMMC are associated with, especially across cultures. This study evaluated VMMC knowledge, misinformation, and stages of change for VMMC of uncircumcised men and boys (over 18 years), as well as the concurrent relationship between VMMC stages of change and sexual risk behaviors.
  
  
  METHODS
  Uncircumcised (N = 800) adult men and boys (over 18) were screened and recruited from urban community health centers in Lusaka, Zambia, where they then completed baseline surveys assessing knowledge, attitudes, HIV risk behaviors, and stages of change for VMMC. A series of analyses explored cross-sectional relationships among these variables.
  
  
  RESULTS
  VMMC was culturally acceptable in half of the sample; younger, unmarried, and more educated men were more ready to undergo VMMC. Stage of change for VMMC was also related to knowledge, and those at greater HIV risk reported greater readiness to undergo VMMC.
  
  
  CONCLUSIONS
  Efforts to increase VMMC uptake should address the role of perceived HIV risk, risk behaviors, readiness, accurate knowledge, cultural acceptance, and understanding of the significant degree of HIV protection conferred as part of the VMMC decision making process. These results support incorporating comprehensive HIV risk reduction in VMMC promotion programs.
authors.affiliation: University of Rhode Island, 130 Flagg Rd., Kingston, RI, 02881, USA. credding@uri.edu.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Redding
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Jones
authors.affiliation: University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Robert
authors.initials: R
authors.lastname: Zulu
authors.affiliation: University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Ndashi
authors.initials: N
authors.lastname: Chitalu
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Cook
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D008297:Male; D015995:Prevalence; D011314:Preventive Health Services / Q000379:methods; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D015024:Zambia / Q000453:epidemiology
keywords: HIV; Knowledge; Readiness; Stages of change; Voluntary medical male circumcision; Zambia