Macintyre, K., Andrinopoulos, K., Moses, N., et al. PLOS ONE (May 2014), 9(4): e83998, doi: 10.1371/journal.pone.0083998.
This qualitative study explored barriers and facilitators to voluntary medical male circumcision (VMMC) services to better understand the low demand for VMMC among men older than 25 years in Turkana, Kenya. This community had no tradition of male circumcision, and high rates of HIV and other sexually transmitted infections. The researchers conducted 20 focus groups and 69 in-depth interviews focusing on the attitudes and perceptions of circumcised and uncircumcised men, and their female partners. Circumcision is not part of Turkana culture, but is common in some neighboring ethnic groups. Study participants cited different types of stigma surrounding VMMC that are not related to HIV. VMMC was associated with younger men, since older men were seen as having little risk of HIV and being “protected” by marriage. Some participants felt that older men accepting circumcision could serve as examples for younger men. Health infrastructure in the area was weak, and respondents expressed concern about service capacity to deliver VMMC. At the same time, VMMC was associated with “modernity,” protection against HIV, and cleanliness. Overall, men and women supported VMMC, but cited numerous barriers. The researchers indicated that strategic and sensitive communication messages and sustained high-quality services could help address these barriers. They emphasized that messages should reinforce VMMC as a medical procedure to reduce HIV risk.