Background: Following WHO recommendations, Zimbabwe embraced voluntary medical male circumcision (VMMC) as a constituent of HIV prevention strategies in 2009. Being a non-circumcising country with an MC prevalence of 10% without wide regional differences, VMMC represented a foreign concept for Zimbabweans. In support of the MoHCC, PSI implemented the national communications strategy to increase demand for VMMC through both mass media and interpersonal communication channels. We conducted three bi-annual national surveys to monitor coverage, knowledge and behavioral factors towards VMMC uptake.
Methods: We analysed data from three national cross sectional household surveys conducted among adults aged 15 to 49 years. A baseline survey was conducted in 2010 (n=2770), followed by two surveys in 2013 (n=2350) and 2015 (n=3467). Data on male circumcision status, knowledge, perceived availability of services and intention of taking up VMMC were collected through individual interviews using structured questionnaires. The interviews were conducted by trained field interviewers and analysis of variance (ANOVA) was run on the parameters to determine changes over time using STATA Version 13.
Results: At baseline in 2010, 11.2% males reported being circumcised. Circumcision uptake increased from 11.8% in 2013 to 24.5% in 2015, (p=0.001). VMMC knowledge increased from 58.3% at baseline to 61.0% and 84.2% in 2013 and 2015 respectively, (p=0.001). Perceived availability of VMMC services increased significantly from 68% in 2013 to 73% in 2015, (p=0.001). Intention to go for circumcision increased initially from 59% at baseline to 63% in 2013 and then decreased to 40% in 2015, (p=0.001).
Conclusions: Knowledge about VMMC and uptake and perceived availability of services increased over time reflecting the impact of demand creation and scaling up of services in Zimbabwe. The initial increase in intention to go for VMMC implies that demand creation was effective to motivate early adopters. More research needs to be conducted to better understand barriers to uptake and identify ways to address these among those segments of males still reluctant to get circumcised.

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