September 23, 2020

Acceptability of a Pilot Intervention of Voluntary Medical Male Circumcision & HIV Education for SCY, Western Kenya

Mia Kibela; Pooja Shah, M.Sc.; David Ayuku, Ph.D.; Dominic Makorib; Eunice Kamaara, Ph.D.; Emily Choge, Ph.D; Joyce Nyairo,Ph.D; Pamela Abuyae; Mary Wahome, Ph.D; Juddy Wachira, Ph.D; Paula Braitstein, Ph.D

Purpose
Street-connected youth (SCY) in Kenya and elsewhere in sub-Saharan Africa are at high risk of HIV. Voluntary Male Medical Circumcision (VMMC) reduces the risk of female-to-male HIV transmission. Circumcision is also a traditional coming-of-age process in many Kenyan ethnic groups. This paper describes the acceptability of VMMC delivered as part of a ten-day healing, educational, and ‘coming-of-age’ retreat implemented as a pilot with SCY.

Methods
Male SCY aged between 12 and 24 living on the street for more than 3 months were eligible to participate. The study took place over 10 days. After medical circumcision, youth participated in education modules. Data collected included qualitative semi-structured exit interviews featuring structured and open-ended questions about factors relevant to this intervention’s acceptability.

Results
There were 116 SCY (median age 14, IQR 13 15) who participated in the study. All were circumcised successfully, with no major complications. The majority of participants (81%) agreed that the circumcision procedure was uncomplicated, and 99% agreed the education was an important part of the initiation process. Thematic analysis of interview data highlighted four factors important to the program’s acceptability: providing food, shelter, security; providing a safe place to heal; including traditional elements; and being with peers.

Conclusions
This novel implementation of VMMC was found to be acceptable to SCY participants and could likely be adapted and scaled for HIV prevention and education with SCY elsewhere in Kenya and sub Saharan Africa where circumcision is part of traditional coming-of-age processes.

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