Men in Nyanza Province, Kenya, Demonstrate Good Understanding of Partial Protection of Male Circumcision

Background. In the midst of scale-up for voluntary medical male circumcision (VMMC) in rural and peri-urban settings in western Kenya, there is concern that men do not adequately understand that circumcision provides only partial protection against HIV. The study goal was to determine men's understanding of partial protection and HIV risk and behavior following VMMC. Methods. Men ages 18-39 recently or planning to undergo VMMC were recruited through clinics or community mobilizers for in-depth interviews. Forty-four participants were asked how they would explain partial protection to others, the meaning of 60% reduction, and to rate their risk of HIV before and after VMMC. Data were thematically coded and analyzed. Results. All participants reported that VMMC provides only partial protection against HIV. Participants explained partial protection as the need to continue using other HIV protective measures such as condoms or faithfulness; with numbers such as a 60% or not 100% protection; and through the perceived mechanism of action including reduced penile bruising or bleeding. Most said their personal HIV risk before VMMC was high or very high and gave an average risk score of 7.5 (out of 10, with 10 being very high risk). Participants said that VMMC would or did reduce their risk moderately and gave an average risk score of 2.9 following VMMC – a reduction of 61.3%. Conclusions. Overall, participants demonstrated good understanding of partial protection, especially circumcised men. Numeric literacy was surprisingly high. VMMC counseling seems to be particularly effective in communicating about partial protection.