Background: Circumcising men with the highest baseline HIV infection risk achieves the greatest absolute risk reduction from male circumcision. In practice, voluntary male medical circumcision (VMMC) programs have relied on age as a proxy for risk. However, previous studies have not reported risk factors according to VMMC client age. We investigated the association between age and self-reported HIV risk factors among clients in a VMMC program led by the Zambia Ministry of Health and Jhpiego.
Methods: In May 2017, a VMMC program began asking clients aged ≥15 years about several HIV risk factors to better inform counseling during preoperative evaluation. Clients were asked about recent (≤6 month) sex with an HIV-positive partner; multiple concurrent sex partners; sex in exchange for money; treatment for sexually transmitted infections (STIs); sex after drinking alcohol; and illicit drug use. We report on client responses from the first five months of implementation (May-September 2017), comparing risks among clients in five age bands (15-19 years, 20-24 years, 25-29 years, 30-39 years, and ≥40 years) using the chi-square or fisher exact test with a significance level of p< 0.05. Data were analyzed only for clients with complete data.
Results: Among 2,846 interviewed VMMC clients during May-September, 2,318 (81.4%) had complete data. Of these, 380 (16.4%) clients reported at least 1 HIV risk factor in the past 6 months, and 153 (6.6%) reported ≥2. The proportion of clients reporting any, ≥2, or any of the six individual risk factors varied by age group (p< 0.05), with all but drug use increasing with age (Table).
Conclusions: A substantial minority of clients in a Zambian VMMC program reported recent risk factors for HIV infection, and the likelihood of reporting a risk increased with age. These findings suggest that targeting men aged ≥20 years for VMMC reaches men at higher risk for HIV infection, and demand creation efforts designed to mobilize these men are warranted. VMMC programs that collect risk information should use it to guide demand creation activities (e.g., mobilizing men at shebeens, STI clinics) and to tailor counseling messages for clients.

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