Kaufman, M.R., Smelyanskaya, M., Van Lith, L.M., et al. PLOS ONE (March 2016), http://dx.doi.org/10.1371/journal.pone.0149892.
This systematic review synthesized literature published between 1990 and 2014 on services for sexual and reproductive health (SRH) and voluntary medical male circumcision (VMMC) for male adolescents in sub-Saharan Africa. The authors' aim was to determine the best age-appropriate practices for this population, and to recommend future research to understand the characteristics of effective adolescent VMMC services. The 70 articles included in the review described numerous barriers that impeded both access to and appropriate delivery of SRH services. These barriers included structural factors, imposed feelings of shame, negative interactions with providers, violations of privacy, fear of pain from the VMMC procedure, and desire to integrate traditional non-medical circumcision methods into medical forms. The studies also pointed to factors that increased service uptake and satisfaction among adolescent males. These included parental and community involvement, a youth-friendly service environment, perception of other benefits from VMMC (aside from HIV risk reduction), and clear understanding of VMMC messages. The authors concluded that reaching male adolescents with a meaningful, comprehensive package that includes SRH and VMMC services would require more action to tailor guidelines, services, and messages to younger clients.