Interpersonal Communication and Uptake of Voluntary Medical Male Circumcision among Married Men in Kenya

Abstract

Voluntary Medical Male circumcision (VMMC) has been identified as one of the methods of reducing the risk of heterosexually acquired HIV and AIDS. Kenya adopted VMMC as an HIV/AIDS intervention in 2008 and has been making remarkable progress towards achieving its male circumcision target. However, uptake of VMMC is lowest among older and married men. The purpose of this study therefore was to find out the influence of interpersonal communication on uptake of VMMC among married men in Teso South Sub County, Kenya. Teso Sub County is among the sub counties with high HIV/AIDS prevalence and low male circumcision prevalence thus a target of the VMMC programme. Four objectives that guided this study were: to establish the influence of interpersonally communicated messages on uptake of VMMC among married men; to examine the influence of interpersonal communication source attribute on uptake of VMMC among married men; to establish the influence of interpersonal communication context on uptake of VMMC among married men; and to determine the intervening influence of demographic factors on interpersonal communication and uptake of VMMC among married men. The study employed a mixed methods sequential cross sectional research design. This combination of both quantitative and qualitative research targeted 377 married men for quantitative approach, whose ages ranged from 20 to 49 years. Quantitative data were collected using household questionnaires. Thirty in-depth interviews were also conducted targeting 15 men who had undergone VMMC after marriage and another 15 uncircumcised men. Descriptive and inferential statistics were used to analyze quantitative data. The findings were presented using tables, text and graphs. Qualitative data were analyzed based on the interative process of description, analysis and interpretation particularly in driving at extracting and understanding emerging themes informed by research objectives and presented narrative using selected quotes that are poignant and/or most representative of the study findings. The findings indicated that trustworthiness was the most considered interpersonal source attribute of VMMC. However, older men preferred expertise of the source while health providers were perceived as experts. Talking about male circumcision is no longer perceived as a taboo topic. However, older men in their 40s hardly disclose information or openly talk about circumcision because they regard it as inglorious. Norms and age are the outstanding impediments to men discussing about male circumcision while age and social norms impeded uptake of VMMC. As a result, interpersonally communicated messages that position VMMC as HIV/AIDS intervention are ineffective in influencing married men seek circumcision. The messages elicit low response efficacy but instead other interpersonal messages are relatively effective in influencing them seek circumcision for other reasons such as peer pressure, penile hygiene and improved sexual performance. Privacy and confidentiality of information shared are critical contextual issues that determine the effectiveness of interpersonal communication about male circumcision. The study recommends integration of interpersonal communication in the design, planning and implementation of VMMC campaigns that uses health workers and circumcised men from the local community as models to educate married men on the benefits of circumcision that should go beyond HIV prevention in addition to addressing the misinformation, fear, shame and stigma older and married men face in seeking and openly talking about male circumcision. Finally, women as spouses and sexual partners to the men need to be incorporated in the VMMC campaign so that they can be catalyst to their partners’ decision to seek circumcision. In sum, VMMC programmes to check HIV/AIDS prevalence should aim to harness interpersonal communication to create demand and sustain uptake of circumcision among married men.