title: Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review.
abstract: BACKGROUND
  Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services.
  
  
  RESULTS
  A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males.
  
  
  CONCLUSIONS
  VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population.
authors.affiliation: Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Kaufman
authors.affiliation: Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America.
authors.forename: Marina
authors.initials: M
authors.lastname: Smelyanskaya
authors.affiliation: Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Van Lith
authors.affiliation: Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Mallalieu
authors.affiliation: Johns Hopkins Center for Communication Programs, Baltimore, Maryland, United States of America.
authors.forename: Aliza
authors.initials: A
authors.lastname: Waxman
authors.affiliation: Population Services International (PSI), Harare, Zimbabwe.
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzhold
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Arik V
authors.initials: AV
authors.lastname: Marcell
authors.affiliation: United Nations Children's Fund (UNICEF), New York, New York, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Kasedde
authors.affiliation: Ministry of Health, Dar es Salaam, Tanzania.
authors.forename: Gissenge
authors.initials: G
authors.lastname: Lija
authors.affiliation: Office of the U.S. Global AIDS Coordinator, U.S. Department of State, Washington, DC, United States of America.
authors.forename: Nina
authors.initials: N
authors.lastname: Hasen
authors.affiliation: Ministry of Health and Child Welfare, Harare, Zimbabwe.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Ncube
authors.affiliation: World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Samuelson
authors.affiliation: National Department of Health, Pretoria, South Africa.
authors.forename: Collen
authors.initials: C
authors.lastname: Bonnecwe
authors.affiliation: United States Agency for International Development (USAID) Washington/Global Health Bureau/Office of HIV/AIDS, Washington, DC, United States of America.
authors.forename: Kim
authors.initials: K
authors.lastname: Seifert-Ahanda
authors.affiliation: United States Agency for International Development (USAID) Washington/Global Health Bureau/Office of HIV/AIDS, Washington, DC, United States of America.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara; D002944:Circumcision, Male / Q000523:psychology / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D034121:Reproductive Health Services