There is need to increase acceptance of voluntary medical male circumcision (VMMC) among men ≥19 years who are at highest risk of incident HIV, but who are under-represented in VMMC programs in sub-Saharan Africa.
Between 2015-2018, we conducted a community cluster randomized trial (5 clusters per arm) to assess community promotion of voluntary medical male circumcision mobilization using a de-medicalized messaging intervention (the “Stylish Man”.) In the intervention arm, VMMC was provided via mobile camps alongside a 3-4 day “Stylish Man Event” (infotainment, games, testimonials by satisfied adopters and their partners, “red carpet” VMMC services for men >19 years, messages stressing VMMC as an adult lifestyle choice rather than just a health service), compared to control arm services provided via standard mobile VMMC camps of the same duration. The primary endpoint was the number and proportion of men aged >19 accepting VMMC services, and the population prevalence/incidence of VMMC among non-Muslim men ≥ 19 in three population-based Rakai Community Cohort Study surveys during the trial. Differentials between intervention and control arms were estimated using rate ratios (RR) and 95% confidence intervals (CI).
The number of men accepting VMMC in the intervention arm (5,992) was higher than in the control arm (4,394); also, the numbers and proportions of acceptors aged >19 was higher in the intervention (n=2,083, 34.8%, than the control arm (n=752, 17.1%, RR= 1.96, 95%CI 1.82-2.11); and the differential was statistically significant in all cluster pairs. The population prevalence of VMMC in men >19 increased over time in both arms and was significantly higher in the intervention compared to the control arm during the first follow up (RR=1.11, 95%CI 1.05-1.18.) The incidence of VMMC was also higher in the intervention arm during the first inter-survey interval (RR=1.71, 95%CI 1.43-2.06), but not at later time points.
Community mobilization/de-medicalized promotion increased VMMC uptake in men aged >19, as reflected in service statistics. Population-level VMMC prevalence in men >19 was initially higher in the intervention arm, but VMMC rates increased in both arms over time and the differential between arms was not sustained. Programs should consider demedicalized approaches to increase VMMC among older men.