Demand Creation

Demand creation for VMMC comprises outreach and communication activities spreading information on the benefits of VMMC and availability of VMMC services. Demand creation for VMMC is aimed at increasing general awareness and uptake of VMMC among target populations. Platforms employed for VMMC demand generation include advocacy (e.g., with community leaders, school teachers); communication with target audiences through different communication channels (e.g., television, radio, print media, interpersonal communication, road shows, social media, SMS reminders, household visits); and community engagement and mobilization.

Effective demand creation addresses barriers to VMMC uptake in contextually relevant ways, informed by research and situational analyses. Among other factors, barriers to VMMC uptake include fear of pain, fear of complications, reluctance to abstain from sex during the healing period, and inaccessibility of services.

UNAIDS and PEPFAR have estimated that achieving 80% circumcision coverage among 15-49 year-olds in 14 priority countries in Eastern and Southern Africa by 2016 and maintaining it through 2025, could avert 3.4 million HIV infections.

Between 2008 and 2015, 11.7 million circumcisions were performed among the target population cumulatively in the priority countries. This demonstrates significant progress, but likely inability to meet the target of 20.3 million circumcisions by the end of 2016. Demand generation remains pivotal for aligning VMMC demand with service delivery.

Quality issues:

  • Lack of coordination between service delivery and outreach/communication teams
  • Inadequate involvement of traditional leaders and community role models
  • Failure of targeting women (sexual partners, mothers, caregivers) as key influencers of the targeted male audience
  • Failure to take into account gender norms of what it means to be a “real man” or a “good man"
  • Failure to take into account cultural norms regarding traditional circumcision practices
  • Perception that circumcision wounds heal quicker during winter compared to the other seasons
  • Limited access to health services in rural areas due to economic and structural barriers
  • Attitude of health care workers providing the services
  • Communication not consistently addressing critical VMMC barriers and motivators (e.g., pain)
  • Lack of standardization in mobilizer training and job aids for ensuring complete and consistent messages
  • Low mobilizer morale because of poor compensation and lack of recognition
  • Lack of site usage data and analysis of site capacity that should be used to inform site operations
  • Disconnect between HIV counseling and testing sites and VMMC sites; HCT sites could serve as referral points to encourage HIV-negative men to get circumcised
  • Lack of age-specific communication and waiting areas; for example, older men might be grouped with adolescent boys for counseling sessions. This is inappropriate for both age groups, as they might not feel comfortable asking questions.

Resources

The document provides recommendations from the USAID ASSIST Project in South Africa for addressing challenges that are commonly experienced in VMMC programs.

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