Background: Among 14 priority countries identified by the World Health Organization for voluntary male medical circumcision (VMMC) scale up, Malawi is among those with the lowest VMMC uptake, indicating an urgent need to increase VMMC demand to enhance HIV epidemic control. This study analyzes the HIV risk profile of men accessing VMMC services in Malawi to provide local demand creation programs crucial information to increase uptake.
Methods: Using latent class analysis, we evaluated the risk profile of 269 men (16 years and older) accessing VMMC services in three districts in southern Malawi and examined any differential VMMC uptake by class membership. Classes were defined based on four HIV risk factors: ever tested for HIV, condom use at last sex, having casual or concurrent sexual partners in the previous three months, and using alcohol before sex in the previous three months. Poisson regression was used to determine if being in the high risk group was associated with specific socio-demographic characteristics, including education, age, marital status, religion, district, and location (urban/rural).
Results: Two distinct classes were identified: high and low/medium risk. Only 8% men in the sample were high risk while 92% were low/medium risk. Results also indicate that men who have a lower level of education (Risk Ratio [RR]: 0.934, p < 0.05) and are in the 19-26 age group (compared to 16-18 age group) (RR: 1.076, p< 0.05) are more likely to be in the high risk group than in the low/medium risk group.

Risk factorsClass 1, Low/medium riskClass 2, High risk
Class prevalence0.920.08
Estimated number in each class24821
Probabilities of risk behaviors given class membership
1. Never been tested for HIV0.320.29
2. No condom use at last sex0.790.43
3. Casual or concurrent partners (prev. 3 mn.)0.081.00
4. Alcohol use before sex (prev. 3 mn.)0.060.47
[Probability of risk factor given class membership]

Conclusions: Findings highlight the importance of understanding the risk profile of men accessing VMMC to design more targeted VMMC demand creation programs. The results indicate a need to implement specialized strategies to improve VMMC uptake among men in the high risk group, who only comprise 8% of those accessing VMMC and who are more likely to be in the 19-26 age group and have a lower level of education.

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