Acceptability of Voluntary Medical Male Circumcision (VMMC) among M-F+ HIV Serodiscordant Couples Kilembe William, Rachel Parker, Kalonde Malama, Hanzunga Halumamba, Tyronza Sharkey, Linda Kimaru, Amanda Tichacek, Anne Lockard, Mubiana Inambao, Susan Allen Rwanda Zambia HIV Research Group

Background VMMC reduces risk of HIV acquisition in men by 60% In cohabiting couples tested together for HIV, % circumcised ~ 12% in HIV negative men despite message on benefits and facilitated referral. Couples voluntary counseling and testing (CVCT) reduces risk of HIV transmission among discordant couples by >2/3. Study aimed to evaluate comprehension and assess attitudes towards VMMC among M-F+ couples in Copper-belt and Lusaka regions of Zambia (2012 – 2015)

Methodology CVCT program month 0 – Identification of M-F+ serodiscordant couples Counseling message on VMMC and its benefits given at pre and post test counseling to the couple. Referral to MC center given to the man Follow up appointment – to enroll in a study to assess impact of CVCT on HIV incidence among discordant couples Questionnaire on acceptability of VMMC administered to men (and woman partner when available) – separately: To ascertain whether man followed up on information and referral given for MC. To determine reasons why referral was not adhered to

Characteristics of M-F+ Couples Interviewed Mean age (standard deviation) Men = 38yrs (11) Women = 33yrs (9) Majority of couples were Christian Mainly monogamous marriage Most Men i.e. 34% and 23% were skilled and unskilled manual workers respectively; 8% Professional Characteristic MenWomen N= 355%N=152% Age group * < > Religion Christian Muslim2000 Other13411 Education* None4153 Primary Secondary Tertiary Marital status * Premarital/ courting Married Monogamous Married Polygamous21675 Cohabiting Unmarried10332 * Denotes characteristics for which actual total is less than N due to some missing values

Circumcision Status at Initial and Follow up Visits By Region Copper-belt Region (N = 187) Lusaka – Region (N = 168) Initial Visit 1 st Follow up Visit

Knowledge on Benefits of VMMC Proportion of Men and Women in M-F+ Who Knew at least One Benefit of MC Aware of any Benefit of MC Men (N=355) Women (N=152) n%n% Yes No Commonest Benefits of MC Cited by M-F+ Couples

Disadvantages of VMMC Cited by M-F+ Couples Proportion of Men and Women Who Cited at Least One Disadvantage Commonest Disadvantages of VMMC Cited by M-F+ Couples Any disadvantage of MC Men (N=355)Women (N=152) n%n% Yes No

Comparison of Reasons for Men not following up on MC Advise/Referral Top 5 reasons by Men (n= 250) Top 5 reasons by Women Partners (n=100)

Responses by women partners to whether they would encourage their partners to undergo MC Reasons given to encourage: Hygienic Reduced risk of HIV Reduces risk of STIs Reasons given to discourage: Not part of Man’s tradition/culture To old for procedure

Conclusion There is high level of knowledge of benefits of VMMC among men and women Women partners are supportive of VMMC Reluctance to access VMMC by men in M-F+ couples is due perceived disadvantages associated with procedure: prolonged time away from work Fear of pain or complications following procedure Cultural reasons CVCT coupled with MC counseling may be a model to scale up VMMC uptake. Counseling messages on MC need to allay anxiety of perceived risks/disadvantages, stress benefits and involve women partners