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. Purpose 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. Method 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.

The Incidence Patterns Model to Estimate the Distribution of New HIV Infections in Sub-Saharan Africa: Development and Validation of a Mathematical Model

“…In Zambia, especially in the Copperbelt and Lusaka provinces, and in Swaziland, the contribution of never married men was very high, a finding that is partly explained by the low prevalence of circumcision in these countries [ 52 ]. Findings from studies investigating the determinants of uptake of voluntary medical male circumcision in these two countries should inform its scale up [ 53 – 56 ], and strategies such as early infant circumcision [ 57 , 58 ] or circumcision among adolescents through school programmes [ 59 ], which are likely to have higher acceptability, should be promoted [ 60 ]. Never married women were also disproportionately affected in Swaziland compared to their population size (see S2 Fig ), and similarly in Zambia, Gabon, the Southern province in Malawi, and Kigali City and the South province in Rwanda.…”

Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

“…The primary outcome measure for the study was VMMC uptake; of the 800 men enrolled, 257 men (experimental condition, n = 161; control condition, n = 96) underwent VMMC during the course of the study. 19 , 22 Secondary outcomes included maintenance of sexual barrier use following VMMC, 19 the acceptability of VMMC, 22 female partner influence on VMMC uptake, 13 and sexual satisfaction following VMMC. The analysis in this article focuses on sexual satisfaction and post-VMMC experiences of the 257 male study participants who underwent VMMC and the 159 female partners who completed post-VMMC questionnaires.…”

Increasing early infant male circumcision uptake in Zambia: Like father like son

“…In a 2012 review, the American Academy of Pediatrics concluded that health benefits of newborn circumcision not only outweigh the risks, but also justify being accessible to all families that choose this option [ 48 ]. Long-term benefits include the prevention of HPV transmission (as a precursor to cervical cancer among adult women) as well as a reduction in risk for UTIs, HIV, and penile cancer [ 50 ]. A more immediate benefit includes an improvement in hygiene [ 15 ].…”