Background: Kenya began rolling out voluntary medical male circumcision (VMMC) in 2008, with a goal of reaching 80% of approximately 1 million uncircumcised males aged 15-49 years by 2013. While over 700,000 males were circumcised by 2013, client demand for VMMC was primarily among younger clients, and uptake was lowest among men aged ≥25 years. We present reasons reported by men ≥25 years for going or not going for VMMC.
Methods: Between May 2014 and December 2015, we conducted a cluster randomized controlled study to assess the impact of two interventions (enhanced interpersonal communication and dedicated clinics for men aged ≥25 years) on the uptake of VMMC. We administered a questionnaire to men aged 25-39 years who were already circumcised at enrollment and those who received VMMC during the study on their reasons for going for VMMC. We also interviewed men who were uncircumcised at enrollment and those who remained uncircumcised at the end of the study, on their reasons for not going for circumcision.
Results: We interviewed 3,200 circumcised men and 2,781 uncircumcised men. For men who were circumcised before the study (n=2,848), reduction in HIV risk (43.7%) (95% CI, 41.9, 45.6) and culture/religion (18.4%) (95% CI, 17.1, 19.9) were the two most important reasons for getting circumcised, while for men circumcised during the study (n=352), reduction in HIV risk (50.9%) (95% CI, 45.6, 55.6) and improved genital hygiene (16.2%) (95% CI, 12.5, 20.2) were the top reasons for getting circumcised. For those uncircumcised at enrollment (n=2,781), lost wages was the main barrier (34.2%) (95% CI, 32.6, 36.0) followed by pain (27.8%) (95% CI, 26.1, 29.4) while among those who remained uncircumcised when the study closed and were interviewed at exit (n=1,265), top barriers were inconvenient time/venue (43.2%) (95% CI, 40.4, 46.0) and lost wages (26.0%) (95% CI, 23.7, 28.5).
Conclusions: Reduction in HIV risk remains the primary reason why men aged 25-39 pursue circumcision while losing wages is the primary reason others remain uncircumcised. Demand creation efforts for older men must amplify key client-level facilitators while overcoming primary barriers.

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