Female Partner Acceptance as a Predictor of Men's Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

Abstract

The World Health Organization has recommended the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention in sub-Saharan Africa; however, men are often uninterested in undergoing VMMC. The Spear & Shield project enrolled 668 men and female partners from ten Zambian community health centers into parallel interventions promoting VMMC for HIV prevention or time-matched control conditions. A mediation model was utilized to examine the relationships between changes in women's acceptance of VMMC and men's readiness to undergo the procedure. Results demonstrated that, at 12 months post-intervention, a 5.9 % increase in the likelihood of undergoing VMMC among men in the experimental condition could be attributed to increased women's acceptance. From a public health perspective, involving women in VMMC promotion interventions such as the Spear & Shield project could significantly impact the demand for VMMC in Zambia.

Keywords: Couples; Voluntary medical male circumcision; Women; Zambia.

Figures

Fig. 1

A path model showing hypothesized mediation relationships between condition, women's VMMC acceptance, and men's readiness to undergo VMMC. Note: VMMC voluntary medical male circumcision, WA women's acceptance, SOC stages of change, T1 baseline, T2 post-intervention (approximately 2 months post-baseline), T3 6-month follow-up, T4 12-month follow-up

Fig. 2

Attendance at the intervention or control sessions, assessment completion rates, and withdrawal/drop-out rates for N = 1336 men and women enrolled in the Spear & Shield project

Fig. 3

Unstandardized relationships between condition, women's VMMC acceptance, and men's readiness to undergo VMMC. Note Statistically significant coefficients are noted in bold; VMMC voluntary medical male circumcision, WA women's acceptance, SOC stages of change, T1 baseline, T2 post-intervention (approximately 2 months post-baseline), T3 6-month follow-up, T4 12-month follow-up

Fig. 4

Standardized path coefficients between condition, women's VMMC acceptance, and men's readiness to undergo VMMC. Note If the predictor variable is continuous, the coefficient was calculated as β = b*SD(x)/SD(y) and represents the amount of change in the outcome, in standard deviations, per one unit change in the standard deviation of the predictor variable, holding all other relationships constant. If the predictor variable is categorical (i.e., study condition), the standardized coefficient was calculated as β = b/SD(y) and represents the difference in the outcome, in standard deviations, between the experimental and control conditions, holding all other relationships constant

Fig. 5

Predicted stage of readiness for VMMC at T4, including estimates for the experimental condition (1) including mediation pathways through women's acceptance (indirect effect p = .013) and (2) excluding mediation pathways through women's acceptance, as well as the control condition