RT Journal Article
SR Electronic
T1 “Man, what took you so long?” Social and individual factors affecting adult attendance at voluntary medical male circumcision services in Tanzania
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 108
OP 116
DO 10.9745/GHSP-D-12-00037
VO 1
IS 1
A1 Marya Plotkin
A1 Delivette Castor
A1 Hawa Mziray
A1 Jan Küver
A1 Ezekiel Mpuya
A1 Paul James Luvanda
A1 Augustino Hellar
A1 Kelly Curran
A1 Mainza Lukobo-Durell
A1 Tigistu Adamu Ashengo
A1 Hally Mahler
YR 2013
UL http://www.ghspjournal.org/content/1/1/108.abstract
AB In a study in Tanzania, men and women generally supported male circumcision; however, cultural values that the procedure is most appropriate before adolescence, shame associated with being circumcised at an older age, and concerns about the post-surgical abstinence period have led to low uptake among older men. Background: In 2009, the Government of Tanzania embarked on scaling up voluntary medical male circumcision (VMMC) services for HIV prevention in 8 priority regions, with the aim of serving 2.8 million boys and men ages 10–34 years by 2013. By mid-2012, more than 110,000 boys and men in Iringa and Njombe regions had received VMMC. The majority (85%) of these VMMC clients were under 19 years old (average age, 16 years). This study aimed to identify potential barriers and facilitators to VMMC among older men. Methods: We conducted 16 focus group discussions, stratified by sex and age, with 142 purposefully selected participants in 3 districts of Iringa and Njombe regions. Results: Both men and women generally had positive attitudes toward VMMC. Social and personal barriers to obtaining VMMC among adult men included shame associated with seeking services co-located with younger boys and perceived inappropriateness of VMMC after puberty, particularly after marriage and after having children. Additional barriers included concerns about partner infidelity during the post-surgical abstinence period, loss of income, and fear of pain associated with post-surgical erections. Facilitators included awareness of the HIV-prevention benefit and perceptions of cleanliness and enhanced attractiveness to women. Conclusions: While men and women in Iringa and Njombe regions in Tanzania generally view VMMC as a desirable procedure, program implementers need to address barriers to VMMC services among adult men. Selected service delivery sites in the Iringa and Njombe regions will be segregated by age to provide services that are “friendly” to adult men. Services will be complemented with behavior change communication initiatives to address concerns of older men, encourage women’s support for circumcision and adherence to the post-surgical abstinence period, and change social norms that inhibit older men from seeking circumcision.