A growing number of men aged 25 to 39 years may have decided against circumcision and no amount of persuasion appears to change their stance, a new study suggests.
While they gave researchers the main reasons for not taking up the cut, which is highly beneficial in preventing HIV, the men kept changing goalposts once their concerns were addressed.
Male circumcision cuts the risk of men acquiring HIV by about 60 per cent, according to studies done in mid-2000s.
Voluntary medical male circumcision (VMMC) uptake in traditionally non-circumcising communities remains lowest among men aged 25 to 39 years, the researchers said in the study published last week in the Plos Global Public Health journal.
Their study, titled "Shifting reasons for older men remaining uncircumcised: Findings from a pre- and post-demand creation intervention among men aged 25–39 years in western Kenya", aimed to decipher why circumcision uptake remains low among this demographic.
They targeted men aged 25-39 in western Kenya between 2014 and 2016.
They evaluated the impact of two interventions-interpersonal communication (IPC) and dedicated service outlets (DSO)-either delivered individually or together.
The researchers said past evidence suggests that interpersonal communication can facilitate a man’s transition from intention to getting circumcised to actual uptake of the services.
They asked the uncircumcised men to rank their top three reasons for avoiding circumcision.
When those concerns were addressed, the men brought up new reasons.
One significant barrier cited was economic concern. As one participant succinctly put it, “I can’t afford to lose a day’s work. What will my family eat?”
This concern remained the most cited reason both at the beginning and end of the study, though the proportion of men citing it dropped from 62 per cent to 28 per cent. Still, many did not get circumcised.
Another barrier that saw a notable shift was the inconvenience of time and venue. Initially ranked third, it fell to seventh place by the study's conclusion. Meanwhile, being "too busy to go for circumcision" climbed from tenth to second place.
The researchers suggest many older men have decided against being circumcised and were just giving different or random reasons at different time points.
These excuses increased to more ludicrous ones such as “penis will shrink, sexual abstinence period long, peer opposed, female partner opposed.”
“The finding of shifting reasons for remaining uncircumcised among men may indicate the role of other important but tacit barriers to VMMC uptake and that other demand creation interventions may be required, but could also mean older men may have just decided they would not get circumcised and no intervention would change their minds,” the authors said.
The researchers also highlighted the influence of social and cultural factors. Some married men, who formed the majority of participants, often avoided circumcision due to suspicions of infidelity or a diminished perception of HIV risk.
One participant admitted, “My wife would think I’m cheating if I suddenly decide to get circumcised now.”
Such societal pressures and misconceptions about circumcision's impact on sexual behaviour and fertility further complicate the decision-making process, researchers said.
The study’s authors recommend exploring additional innovative interventions to address these ongoing and shifting barriers.
They emphasise the need for tailored approaches that consider the complex interplay of economic, social and cultural factors influencing men's decisions.
"Economic interventions might be necessary to enhance VMMC uptake among economically disadvantaged men," the study suggests.
The authors are from the Impact Research and Development Organisation, Kenya Medical Research Institute, US Centers for Disease Control and Prevention and Jaramogi Oginga Odinga University of Science and Technology.
Kenya started implementing voluntary medical male circumcision for HIV prevention in 2008.
An assessment in 2021 suggested MC prevalence for 15-29-year-old men was above 75 per cent in Homa Bay, Kisumu, Siaya and Migori, which are traditionally non-circumcising.
For young adolescents 10–14 years, the observed prevalence was below 74 per cent.
However, lack of VMMC campaigns and decreased funding has seen the exercise lose momentum.
