Background: The South African government has been scaling-up VMMC services since 2010. However, South Africa has continued to miss its VMMC targets, indicating that more is needed in terms of understanding the slow uptake of VMMC services. The objective of this study is to determine the factors that contribute to low VMMC uptake with the aim of proposing strategies to improve VMMC demand creation for older adult males (20-39 years).
Methods: By employing a qualitative research methodology, the study explores the factors and barriers that contribute to the low VMMC uptake of adult males. A purposive sampling method was used to select 4 Program Managers from the National and Gauteng Provincial Department of Health. In addition, 20 uncircumcised males between the ages of 20 and 39 in Gauteng province were interviewed via focus group discussions.
Results: The main findings show that there are various contextual, individual and community factors contributing to the low VMMC uptake. Interviews with Program Managers revealed that:
1) there was no clear demand generation strategy in place,
2) no clear relationship between VMMC demand creation and actual uptake,
3) lack of human capital,
4) poor integration between VMMC and other prevention programs,
5) a lack of VMMC program leadership, and
6) a lack of resources.
Focus group discussions with uncircumcised males found several key deterrents to VMMC uptake, including:
1) fear of pain and adverse events,
2) a lack of confidence in the public health system,
3) the requirement of abstinence for 40 days after circumcision,
4) potential loss of income,
5) cultural and religious concerns,
6) HIV testing requirements,
7) peer pressure and
8) circumcision-related stigma.
Conclusions: There is a need to understand the lack of VMMC uptake both from the provider and the consumer perspectives. In many cases, the barriers to uptake identified by Program Managers were not identified as important by uncircumcised males, and vice versa. Among the uncircumcised males, barriers included a combination of real concerns, interspersed with myths, fears and false beliefs.