Moving men through the decision making process for Voluntary Medical Male Circumcision (VMMC): An analysis of early versus late adopters

Introduction: VMMC is an important HIV intervention.  We examined differences between early and late adopters of VMMC to inform demand creation activities.   

Methods:  A cross-sectional survey was facilitated with VMMC clients in rural Tanzania (n=320). Bivariate and multivariate logistic regression was conducted that controlled for access to VMMC services.  Standardized weights were applied.   

Results: Sixty-five percent (65%) of participants delayed six months or more between first hearing about VMMC and choosing to undergo the VMMC procedure.  Most reported cleanliness (95%), protection from disease (92%) and HIV (89%) as motivators;  a desire for increased respect and status from men (58%) was also reported, especially among late adopters (adjusted odds ratio (aOR) 2.10, p=.003).  Late adopters were more likely to perceive that the majority of men in their community were circumcised (aOR 1.79, p=.015).  They were less likely to perceive that HIV testing as part of VMMC influences a man’s decision for VMMC (aOR .50, p=.011), but more likely to report the test as a problem in their own decision making (aOR 2.29, p=.039).   Late adopters had greater exposure to VMMC messaging through media (aOR 2.30, p=.011) and family or friends (aOR 1.63, p=.016). 

Conclusions: Many men don’t act immediately when learning about VMMC.  The transtheoretical model of behavior change and a focus on social norms may benefit programs aiming to move men through the decision making process.  Messaging about protection from disease and HIV is also important.  The role of HIV testing as a barrier to uptake should be explored further.