The WHO and UNAIDS have set a Fast-Track goal to achieve 90% coverage of voluntary medical male circumcision (VMMC) among males aged 10-29 years in priority settings by 2021. Little is known about age-specific facilitators of VMMC uptake among adolescents.
Younger (10-14 years; n=967) and older (15-19 years; n=559) adolescent males completed structured interviews prior to receiving VMMC counseling at 14 service provision sites across South Africa (4 sites; n=446), Tanzania (4 sites; n=540), and Zimbabwe (6 sites; n=540) about perceptions of and motivations for VMMC. Adjusted prevalence ratios (aPR) were estimated by multivariable modified Poisson regression with generalized estimating equations and robust standard errors to account for site-level clustering.
The majority of adolescents in both age groups reported a strong desire for VMMC. Compared to older adolescents, younger adolescents were less likely to cite HIV/STI protection (aPR=0.77 [95%CI=0.66-0.91]) and hygienic reasons (aPR=0.77 [95%CI=0.66-0.91]) as their motivation to undergo VMMC, but were more likely to report being motivated by advice from others (aPR=1.88 [95%CI=1.54-2.29]). While most adolescents believed that undergoing VMMC was a normative behavior, younger adolescents were less likely than older adolescents to perceive that the majority of their peers were already circumcised (i.e., higher descriptive norms; aPR=0.79 [95%CI=0.71-0.89]), higher injunctive norms (aPR=0.86 [95%CI=0.73-1.00]), and higher anticipated stigma from peers/girls for being uncircumcised (aPR=0.79 [95%CI=0.68-0.90]). Younger adolescents were also less likely than older adolescents to correctly cite that VMMC offers males partial HIV protection (aPR=0.73 [95%CI=0.65-0.82]). Irrespective of age, adolescents’ main concern about undergoing VMMC was pain (aPR=0.95 [95%CI=0.87-1.04]). Among younger adolescents, fear of pain was negatively associated with desire for VMMC (aPR=0.89 [95%CI=0.83-0.96]).
Age-specific strategies are important to consider for sustainable VMMC demand generation. Programmatic efforts to create and sustain VMMC demand should consider building on the social norms surrounding VMMC and aim to alleviate fears about pain. There is also a need to correct the misperceptions surrounding the level of HIV protection VMMC offers.