Voluntary medical male circumcision (VMMC) provides at least a 60% protective effect against HIV infection for men, but, while service delivery for VMMC has improved, uptake has stalled. In response, the Bill & Melinda Gates Foundation funded Ipsos Healthcare, a market research company, to investigate how to better understand behavioural and psychographic characteristics of men and boys and the barriers and facilitators within their journey from awareness of the VMMC to uptake.

Much is known about why men undergo VMMC, but those reasons and how men’s beliefs influence decisions to opt for it have not been systematically mapped.

The stages a man goes through when deciding to have VMMC in Zambia and Zimbabwe were documented in order to understand the path to the decision, what affected their decision, the roles of key influencers and how boys and men tend to take different paths to VMMC, depending on their age. Ipsos discovered that, on average, it took men two years and three months to move from awareness of VMMC to having the procedure.

Ipsos surveyed 2000 men between the ages of 15 and 30 in the two countries. The findings showed that men fall into six groups with respect to their attitudes towards VMMC and wanted answers regarding five themes: sex appeal; procedure; pain; social support; and the benefits.

With support from the Bill & Melinda Gates Foundation to translate this research to practice, PSI Zimbabwe and the Society for Family Health, Zambia, used the results of the research to fine-tune and tailor messages to different groups of men. The research also improved the confidence of community workers in delivering previously uncomfortable messages, especially on pain and sex.

PSI Zimbabwe and the Society for Family Health, Zambia, prioritized the different groups by group size, ease of conversion, ability to advocate with peers and risk behaviour. After analysis of the research, they created “personas” of each group and identified areas where programmes and specific messaging could have the most impact.

Community workers mobilizing demand for VMMC report that they are able to quickly identify potential clients from the prioritized groups and target age groups. They are seeing fewer men but achieving a higher conversion rate as a result of the shift from group discussions to one-on-one discussions based on the research. 

PSI Zimbabwe and the Society for Family Health, Zambia are now piloting messages and final concepts before scaling up programmes for the long-term sustainability of VMMC implementation.