Immediate Motivators to Seeking Voluntary Medical Male Circumcision Among HIV-Negative Adult Men in an Urban Setting in Botswana.

Randomized trials have shown that voluntary medical male circumcision (VMMC) significantly reduces HIV acquisition risk in men. We sought to identify subpopulations of Botswanan men with high levels of VMMC uptake by comparing an observational cohort of men presenting for circumcision services at two high-volume clinics in Botswana's capital city, Gabo-rone, with a matched, population-based random sample of uncircumcised men. Among these high uptake VMMC subpopulations, we then examined the immediate factors that play a role in men's decision to seek VMMC services. As compared to their population-based controls, men choosing to undergo circumcision were more likely to be ages 24-34, more highly educated, to have a religious affiliation, and in a serious relationship. Our results suggest that married men and highly educated men were more likely to pursue circumcision for personal hygiene reasons. These findings have direct implications for targeted demand creation and mobilization activities to increase VMMC uptake in Botswana.

[1]  C. Hankins,et al.  Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography , 2016, PloS one.

[2]  E. Njeuhmeli,et al.  Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe , 2016, PloS one.

[3]  M. Keetile,et al.  Factors associated with acceptability of child circumcision in Botswana -- a cross sectional survey , 2016, BMC Public Health.

[4]  C. Hankins,et al.  Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014 , 2016, PloS one.

[5]  S. Lockman,et al.  Botswana's progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: a population-based survey. , 2016, The lancet. HIV.

[6]  K. Wirth,et al.  Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana , 2016, AIDS care.

[7]  A. C. Ncube,et al.  Association between wanting circumcision and risky sexual behaviour in Zimbabwe: evidence from the 2010–11 Zimbabwe demographic and health survey , 2015, Reproductive Health.

[8]  E. Moyer,et al.  Sex is never the same: Men's perspectives on refusing circumcision from an in-depth qualitative study in Kwaluseni, Swaziland , 2015, Global public health.

[9]  Lucia Knight,et al.  ‘If you are circumcised, you are the best’: understandings and perceptions of voluntary medical male circumcision among men from KwaZulu-Natal, South Africa , 2015, Culture, health & sexuality.

[10]  C. Hart,et al.  Identifying and Addressing Barriers to Uptake of Voluntary Medical Male Circumcision in Nyanza, Kenya among Men 18–35: A Qualitative Study , 2014, PloS one.

[11]  J. Bertrand,et al.  Attitudes, Perceptions and Potential Uptake of Male Circumcision among Older Men in Turkana County, Kenya Using Qualitative Methods , 2014, PloS one.

[12]  F. Cowan,et al.  Barriers and Motivators to Voluntary Medical Male Circumcision Uptake among Different Age Groups of Men in Zimbabwe: Results from a Mixed Methods Study , 2014, PloS one.

[13]  Bruce Rhodes,et al.  Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu–Natal, South Africa , 2014, African journal of AIDS research : AJAR.

[14]  S. Adebajo,et al.  Comparison of Audio Computer Assisted Self-Interview and Face-To-Face Interview Methods in Eliciting HIV-Related Risks among Men Who Have Sex with Men and Men Who Inject Drugs in Nigeria , 2014, PloS one.

[15]  R. Gray,et al.  Contextual Barriers and Motivators to Adult Male Medical Circumcision in Rakai, Uganda , 2013, Qualitative health research.

[16]  P. Gorbach,et al.  Effect of Computer-Assisted Interviewing on Self-Reported Sexual Behavior Data in a Microbicide Clinical Trial , 2013, AIDS and Behavior.

[17]  N. Hens,et al.  Evaluating audio computer assisted self-interviews in urban south African communities: evidence for good suitability and reduced social desirability bias of a cross-sectional survey on sexual behaviour , 2013, BMC Medical Research Methodology.

[18]  S. Lockman,et al.  Acceptability of Male Circumcision Among Adolescent Boys and their Parents, Botswana , 2012, AIDS and Behavior.

[19]  K. Chrouser,et al.  Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services , 2011, PLoS medicine.

[20]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[21]  Laith J. Abu-Raddad,et al.  Understanding the Impact of Male Circumcision Interventions on the Spread of HIV in Southern Africa , 2008, PLoS ONE.

[22]  S. Kalichman,et al.  HIV/AIDS Risks among Men and Women Who Drink at Informal Alcohol Serving Establishments (Shebeens) in Cape Town, South Africa , 2008, Prevention Science.

[23]  N. Nagelkerke,et al.  Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa , 2007, BMC infectious diseases.

[24]  Stephen Moses,et al.  Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial , 2007, The Lancet.

[25]  Oliver Laeyendecker,et al.  Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial , 2007, The Lancet.

[26]  R. Bailey,et al.  Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review , 2006, AIDS and Behavior.

[27]  James O Lloyd-Smith,et al.  The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa , 2006, PLoS medicine.

[28]  Emmanuel Lagarde,et al.  Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial , 2005, PLoS medicine.

[29]  S. Lockman,et al.  Male circumcision: an acceptable strategy for HIV prevention in Botswana , 2003, Sexually transmitted infections.

[30]  S. Saxena,et al.  Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa. , 2006, Social science & medicine.