- Kenya was an early adopter having launched the National Program of Voluntary Medical Male Circumcision in 2008
- Men also preferred to be circumcised by people of their age, not younger, and shirked at female circumcisers
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What kind of circumcision centres would older men be more comfortable with?
Eight researchers, perturbed by the stubbornly low uptake of voluntary medical male circumcision among men above 30 years, have now found some answers.
They conducted 24 focus group discussions and 48 in-depth interviews to understand the factors that influence older men’s uptake of VMMC.
The men interviewed were 25-39 years old, all from traditionally non-circumcising communities. Their female partners were also interviewed.
The majority of men preferred facilities that were not attended by adolescent boys for circumcision.
These facilities were preferably hospitals from Level 4 and above.
“Both females and males considered it culturally inappropriate for a man to attend circumcision services with adolescent boys because of a need to maintain social boundaries,” the authors, who include renowned HIV researcher Prof Kawango Agot, said.
The other researchers are Dickens Omondi from the Jaramogi Oginga Odinga University of Science and Technology; and Spala Ohaga and Jacob Onyango from the Impact Research and Development Organization.
Cathy Toroitich-Ruto, Caroline Kambona and Elijah Odoyo-June from the US Centers for Disease Control and Prevention in Nairobi made the rest of the team.
Male circumcision is key in preventing HIV because it cuts the risk of acquiring the virus by about 60 per cent among men, according to studies.
It has been key in reducing new HIV infections in Kenya by 78 per cent; from 101,448 in 2013 to 22,154 cases in 2022.
Kenya adopted VMMC in 2008 following advice from the World Health Organization and the Joint United Nations Program on HIV/ AIDS (Unaids).
The researchers found nearly 80 per cent of men aged 15–29 years were circumcised in the early years of the campaign.
“However, by 2015, the proportion of circumcised men aged above 30 years was only about 5 per cent compared to 48 per cent of 10–14 years, which highlighted probable access and demand barriers,” they said.
This concern is what informed their study, titled 'Facility characteristics preferred by older men seeking medical male circumcision services in Kenya'.
Results were published last week in the BMC Public Health journal.
They noted regions with higher HIV burden simultaneously host traditionally non-circumcising ethnic groups.
Also, new HIV cases are still more commonly reported in traditionally non-circumcising counties.
The results show older men would prefer health facilities that are far away, in the hope of circumventing potential stigma and other social challenges. Even then, this had to be discreet.
“In addition, participants needed to be certain that the facility they opted to attend offered VMMC services, was ‘well equipped’ to perform circumcisions safely and, if needed, provide referral for complicated cases and treatment for sexually transmitted infections,” the researchers said.
The requirement for HIV testing as part of VMMC services was identified as problematic for men, but not all participants had the same idea.
This was attributed to the fear of testing positive for infection; the perceived potential likelihood for results to rock relationships with peers, sexual partners or parents; and the likelihood of individuals becoming fretful and despondent.
“On the other hand, some of the female participants considered circumcision as well as HIV testing services as both important health services, just like any other medical interventions and should not be a problematic issue for men seeking VMMC services.”
Provider characteristics were also important as many men felt only male professionals should perform circumcision.
They also preferred to be circumcised by people of their age, not younger, and of their gender, saying “female staff might unduly massage the male genital at surgery.”
“Technical skills were perceived as essential to the management of post-circumcision challenges such as infections and timing of resumption of sexual activity,” the authors said.
“Preferably, the facility needed to be ‘friendly, clean and well maintained, with flexible service hours daily throughout the week and ensures privacy’.”