Creator: Rebecca Hershow
Source: International Initiative for Impact Evaluation (3ie)
Date of Publication: February 2013
Source Type: Partner
Based on results from three randomized controlled trials, voluntary medical male circumcision (VMMC) has been shown to reduce HIV acquisition by about 60 percent for men. In response, WHO and UNAIDS have pushed for the implementation of VMMC programmes as a component of comprehensive HIV prevention strategies in countries with low male circumcision (MC) rates and high HIV prevalence or high risk for HIV infection. Despite support from several large global initiatives, only 555,202 males had been circumcised in priority countries at the end of 2010. The goal was to reach 20 million males.
This scoping report was produced to support International Initiative for Impact Evaluation (3ie) in promoting implementation of innovative MC uptake interventions. The report presents a literature review, a review of previous or current interventions, and a review of available evaluation evidence on the effectiveness of these interventions. The report delineates between two types of MC uptake interventions – supply-side (i.e. mobile clinics to improve access to MC) and demand-side (i.e. communication activities with MC-related messages). This report focuses on demand-side interventions.
Based on findings from VMMC studies, the report states that major barriers to MC uptake found in demand-side interventions are fear of pain, costs, complications and lengthy healing periods, and perceived threats to masculinity. The major facilitators to MC uptake are peer pressure and influence of female intimate partners.
Although the main intervention used by countries is behavioral change communication, there is little evidence that these communication activities have been effective.
Using peer educators to promote MC uptake is an under-researched and under-utilized strategy. The MCUTS Trial in Zimbabwe will provide valuable information on the strengths and weaknesses of peer education.