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Background: Voluntary medical male circumcision (VMMC) in sub-Saharan Africa has reached a large number of adolescent males (ages 10-19). While some research has evaluated what attracts these boys to services, little is known as to female adolescents'' involvement, if any, in the decision-making process and support of males being circumcised. This study explored adolescent girls'' support of their male peers and sexual partners undergoing the procedure.
Methods: Twelve focus group discussions (FGDs) were conducted with female adolescents (ages 16-19) in South Africa, Tanzania, and Zimbabwe. These FGDs focused on the girls'' opinions and perceptions of VMMC, including their perceived influence on VMMC uptake. In addition, 92 interviews were conducted with male adolescent VMMC clients 6-8 weeks post-procedure, which asked about their experiences in sharing their VMMC status or experience with girls. Audio recordings were transcribed, translated into English, and coded by two independent coders using qualitative coding software. Coders discussed discrepancies until at least 85% agreement was reached. Coded text was then assessed for themes.
Results: Overall, girls are supportive of VMMC. Girls discussed preferring circumcised male sexual partners over uncircumcised ones, citing the formerĀ“s sexual appeal, hygiene, better sexual performance, and reduced chances of passing on infections (including HIV). Additionally, girls discussed being supportive of boys'' decision to be circumcised and both overtly and covertly influencing their peers/partners to undergo VMMC. This was corroborated by some older boys who described how girls made them feel that if they got circumcised, then such girls would be more interested in them. In some instances, older boys reported girls using VMMC as criteria for selecting male partners. Girls discussed not necessarily offering tangible support during the healing process, but rather emotional support in making the decision to get circumcised. Younger boys (< 15 years) reported not interacting with girls much at all regarding VMMC.
Conclusions: Findings show that adolescent girls are involved in the VMMC decision-making process, especially with older adolescent boys. Given the apparent role of female peers/partners as support in influencing VMMC uptake, demand creation initiatives should continue to engage females in promoting VMMC to their male counterparts.

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