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ORIGINAL ARTICLE
Open Access

Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies

Sema K Sgaier, James Baer, Daniel C Rutz, Emmanuel Njeuhmeli, Kim Seifert-Ahanda, Paulin Basinga, Rosie Parkyn and Catharine Laube
Global Health: Science and Practice June 2015, 3(2):209-229; https://doi.org/10.9745/GHSP-D-15-00020
Sema K Sgaier
aBill & Melinda Gates Foundation, Global Development Program, Integrated Delivery, Seattle, WA, USA, and University of Washington, Department of Global Health, Seattle, WA, USA. Now with Surgo Foundation, Seattle, WA, USA, and Harvard T.H. Chan School of Public Health, Boston, MA, USA
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James Baer
bBill & Melinda Gates Foundation, Independent Consultant, London, UK
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Daniel C Rutz
cUS Centers for Disease Control and Prevention, Atlanta, GA, USA
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Emmanuel Njeuhmeli
dUS Agency for International Development, Division of Global HIV/AIDS, Washington, DC, USA
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Kim Seifert-Ahanda
bBill & Melinda Gates Foundation, Independent Consultant, London, UK
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Paulin Basinga
eBill & Melinda Gates Foundation, Global Development Program, Integrated Delivery, Seattle, WA, USA
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Rosie Parkyn
fBBC Media Action, London, UK
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Catharine Laube
gUS Department of State, Office of the US Global AIDS Coordinator, Washington, DC, USA
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  • FIGURE 1.
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    FIGURE 1.

    Components of Demand Generation for Voluntary Medical Male Circumcision (VMMC)

  • FIGURE 2.
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    FIGURE 2.

    Behavior Change Continuum for Voluntary Medical Male Circumcision (VMMC), Based on Insights from VMMC Program in Zimbabwe

    Key: +, motivators; –, barriers.

  • FIGURE 3.
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    FIGURE 3.

    User‐Centric Behavioral Framework for Voluntary Medical Male Circumcision

  • FIGURE 4.
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    FIGURE 4.

    Addressing Barriers to Voluntary Medical Male Circumcision in Kenya: An Evidence-Based, 360°, Well-Coordinated, Evolving Approach

  • FIGURE 5.
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    FIGURE 5.

    Identifying the “Interest Deficit” for Voluntary Medical Male Circumcision (VMMC)

  • FIGURE 6.
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    FIGURE 6.

    The “Interest Deficit” for Voluntary Medical Male Circumcision (VMMC) in Selected VMMC Priority Countries of Eastern and Southern Africa

    Data (and age range) based on country studies: Tanzania (ages 18–44),79 Kenya (ages 15–49),80 South Africa (ages 15–49),81 Rwanda (ages 15–59),82 Uganda (ages 18–80),83 Swaziland (ages 15–29),84 Malawi (ages 15 and older),85 Namibia (ages 15–29),84 Botswana (ages 15–29),84 Zambia (ages 15–59).86

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    TABLE. Summary of 27 Promising-Practice Interventions for VMMC
    Country and Name/Description of InterventionTypes of InterventionsImplementing PartnerBrief Description
    KENYA
    Demand creation toolkitResearch, messaging, social mobilization, IPCImpact Research and Development Organization (IRDO)Tool to assist social mobilizers to communicate consistent messages during IPC
    Journalism trainingMediaInternewsTraining journalists to report accurately and impartially on VMMC
    MCC coordinationCoordinationNational AIDS & STI Control Programme (NASCOP)National and provincial coordination
    MALAWI
    BRIDGE II projectSocial mobilization, IPC, engaging traditional leaders and female partners, coordination, messaging incentivesJohns Hopkins Center for Communication Programs (CCP)Combining low- and high-intensity efforts at behavior change, balancing supply and demand, and reaching female partners
    Lilongwe district scale-upSocial mobilization, media, IPC, engaging traditional leaders and female partners, coordinationInternational Training & Education Center for Health (I-TECH)Using satisfied VMMC clients as community mobilizers and training women to reach other women
    SOUTH AFRICA
    Brothers for LifeSocial mobilization, IPC, media, ICT, messagingJohns Hopkins Health and Education in South Africa (JHHESA)Award-winning multipronged and adaptable marketing and awareness campaign involving print media, TV, billboards, community outreach projects, canvassing, education, and information
    CareWorksSocial mobilization, IPC, ICT, incentives paymentCareWorksWorkplace programs and a call center to move potential clients from contemplation to action
    Centre for HIV and AIDS Prevention Studies (CHAPS)Social mobilization, IPC, research, incentives and performance-based paymentCHAPSRecord numbers of VMMCs performed, perpetual research, reflection and revision of strategy, tight feedback loop with mobilizers, collective incentive structure translated into highly motivated staff
    New StartSocial mobilization, engaging traditional leaders, messaging, research, mediaSociety for Family Health (SFH)Use of the DELTA process to design demand creation interventions and pretesting of all materials
    Soul CityResearch, messaging, mediaSoul CityInsertion of VMMC storylines into long-running TV series
    TANZANIA
    Champion projectSocial mobilization, IPC, engaging female partners, mediaEngenderHealthBeyond HIV messaging, engendering long-term commitment of social mobilizers
    Community mobilization and GIS technologySocial mobilization, IPC, media, engaging female partners, research, advocacy, IPCJhpiegoCommunity mobilization for older men, use of SMS and GIS technology
    Community mobilization and SMS technologySocial mobilization, IPC, ICTIntraHealth and Tanzania Youth Alliance (TAYOA)Innovative approach combining SMS technology with popular-opinion leaders at grassroots level to create tailored strategy for reaching older men, adaptation of IEC materials to suit local communities
    Printed materials and radio spotsMedia and messagingCCPPrinted materials and radio spots
    UGANDA
    AMAKA (Adult Male Medical Circumcision in Kampala)Social mobilization, researchInfectious Diseases InstituteUse of existing community resources and structures for demand creation
    Be the Pride of Your Tribe campaignSocial mobilization, advocacy, researchSTAR-EVMMC campaign in traditionally circumcising communities
    Makerere University Walter Reed ProjectSocial mobilization, advocacy, media, IPC, researchUS Military HIV Research ProgrammeUse of cross-country learning to create VMMC demand and meet VMMC need
    Stand Proud, Get Circumcised campaignResearch, messaging, social mobilizationHealth Communication Partnership (HCP)Use of research to inform communication strategy development and implementation, national tools with standardized branding and information to ensure consistency and recognition of VMMC but which can also be tailored to specific communities and contexts
    Stylish Man campaignResearch, media, messaging, IPCRakai Health Sciences ProgramDemedicalizing demand creation for VMMC
    ZAMBIA
    Community mobilizationSocial mobilization, IPC, media, engaging female partnersMarie Stopes InternationalCommunity mobilization, health counselor training, and local media
    Community mobilization and campaignsSocial mobilization, research, ICTSociety for Family HealthCommunity mobilization through existing volunteer structures, mobile clinical outreach, client voucher/feedback system to disaggregate effective elements of demand creation, and toll-free family planning help lines incorporate VMMC
    Mini campaigns and trainingSocial mobilization. IPC, media, advocacyJhpiegoClose linking of demand creation activities with supply, including mini campaigns to marry the two and emphasis on a positive client experience
    National MC Month and technical working groupMass media communication, advocacy, engaging tribal leaders, community mobilization, IPCNational technical working groupNational and district-level coordination, advocacy by traditional leaders and public officials, thrice yearly MC drives and engagement with health workers
    Safe Love campaignResearch, media, messaging, IPC, ICT, community mobilizationCommunications Support for HealthInnovative multiplatform, multi-format content, use of SMS to move from contemplation to action
    U Report SMS pilotICT, advocacy, community mobilization, IPCUnited Nations Children’s Fund (UNICEF)SMS pilot for VMMC demand creation among adolescents and young adults
    ZIMBABWE
    Identifying optimal messagingResearch, messagingBattelle Health and AnalyticsQualitative and quantitative research to establish optimal messages to promote demand for VMMC
    SMART campaignMessaging, media, social mobilization, IPCPopulation Services International (PSI)Research-led message development for “SMART” campaign, management of social mobilization
    • Abbreviations: GIS, geographic information system; ICT, information and communications technology; IEC, information, education, and communication; IPC, interpersonal communication; MC, male circumcision; SMS, short message service (text message); VMMC, voluntary medical male circumcision.

Additional Files

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  • GHSP-D-15-00020 Supplementary Material

    Sgaier et al. doi: 10.9745/GHSP-D-15-00020

    • Supplementary Material - Sgaier et al. doi: 10.9745/GHSP-D-15-00020
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Global Health: Science and Practice: 3 (2)
Global Health: Science and Practice
Vol. 3, No. 2
June 01, 2015
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Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies
Sema K Sgaier, James Baer, Daniel C Rutz, Emmanuel Njeuhmeli, Kim Seifert-Ahanda, Paulin Basinga, Rosie Parkyn, Catharine Laube
Global Health: Science and Practice Jun 2015, 3 (2) 209-229; DOI: 10.9745/GHSP-D-15-00020

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Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies
Sema K Sgaier, James Baer, Daniel C Rutz, Emmanuel Njeuhmeli, Kim Seifert-Ahanda, Paulin Basinga, Rosie Parkyn, Catharine Laube
Global Health: Science and Practice Jun 2015, 3 (2) 209-229; DOI: 10.9745/GHSP-D-15-00020
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  • Article
    • Abstract
    • INTRODUCTION
    • FRAMEWORK FOR VMMC DEMAND GENERATION
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  • Effectiveness of an intervention to increase uptake of voluntary medical male circumcision among men with sexually transmitted infections in Malawi: a preinterventional and postinterventional study
  • Uptake of voluntary medical male circumcision among men with sexually transmitted infections in Lilongwe, Malawi: a protocol for a pre-interventional and post-interventional study
  • Effectiveness of Demand creation promotions and demand creation personnel in creating demand for Voluntary Medical Male Circumcision in Chitungwiza district, Zimbabwe in 2016
  • Long-Term Investment for Infants: Keys to a Successful Early Infant Male Circumcision Program for HIV Prevention and Overall Child Health
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