What are the social and individual factors that are associated with undergoing male circumcision as an HIV prevention strategy? A mixed methods study in Malawi

Background: There is compelling evidence that medical male circumcision (MMC) decreases transmission of HIV. Nevertheless, the uptake of MMC is generally very low. Understanding the characteristics of individuals who choose MMC could inform future strategies for scaling-up MMC. The main objective of this study was to explore the social and individual characteristics of men that are associated with the uptake of circumcision as an HIV prevention strategy. Methods: Amixed-methods study, comprising a cross-sectional survey and an exploratory qualitative study, was conducted in Malawi. Atotal numberof 1644 men, of at least 18 years old, participated in this study. Amultistage sampling approach was used in the survey while convenience sampling was adopted in the qualitative study. Descriptive statistics, bivariate analyses and multivariable logistic regression were performed to analyze the cross-sectional data and thematic content approach to analyze the qualitative data. Results: Individuals who chose MMCweremore likely to be unemployed (AOR=1.65; 95% CI 1.30-2.11), to bemarried (AOR=3.16;95%CI 2.21-4.52) and to have had exposure toMMCpromotions (AOR=1.81; 95%CI 1.41-2.33). Theywere also more likely to reside in rural areas (AOR=1.85; 95% CI 1.44-2.38), to perceive themselves as more vulnerable to HIV (AOR=1.60; 95% CI 1.19-2.15) and to be more knowledgeable about the benefits of MMC (AOR=1.51; 95% CI 1.16-1.97). Conclusions: The findings suggest that men who had certain social and individual characteristics (for example better knowledge of the benefits of MMC, greater perceived vulnerability to HIV, married and unemployed) were more likely to choose circumcision as a prevention strategy for HIV than those who lacked those characteristics. Strategies for increasing MMC take-up should recognize the current social/individual landscape of MMC uptake and ensure that deliberate efforts targeting marginalized categories of men are available.