Abstract
Voluntary medical male circumcision (VMMC) may be incorporated into HIV prevention services for men who have sex with men (MSM). We conducted a mixed-methods study to elucidate barriers and facilitators to, and experience of, VMMC among MSM. Participants were MSM aged 18 years and older who were enrolled in an ongoing multicenter randomized controlled trial (RCT) to evaluate VMMC to prevent HIV among MSM in China. RCT participants completed a questionnaire before and after VMMC to assess perceptions of and complications after the procedure. A subset of RCT participants were selected for in-depth interviews. Interviewees answered open-ended questions about barriers and facilitators to and experience of undergoing VMMC. Six-step thematic analysis incorporating inductive and deductive approaches was used to interpret interview responses. A total of 457 MSM completed the pre-VMMC survey, 115 circumcised MSM completed post-VMMC surveys, and 30 MSM completed an interview. Main barriers to VMMC uptake were concerns about pain, length of wound healing, cost, lack of knowledge about or misconceptions of VMMC, and stigma related to surgery. Facilitators to VMMC could be categorized as internal factors (foreskin) and external factors (motivation and follow-up care). Interestingly, the VMMC experiences of others could be transformed from a barrier into a facilitator to VMMC in some circumstances. After VMMC participants transitioned from a negative state of pain, remorse, difficulty sleeping, and discomfort to a positive state of symptom alleviation and personal hygiene improvement. Optimizing facilitators and addressing barriers may encourage VMMC among MSM. Joint efforts should be made by relevant stakeholders to improve the awareness and uptake of VMMC among MSM.
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The data collected in this study will not be publicly available. However, the corresponding author can be contacted for de-identified data upon reasonable request.
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Acknowledgements
We thank the following organizations and individuals for their support: Yuewei Zhan, Weiran Zheng, and Qingdao Youth Living with HIV Volunteer Service Center. We are very thankful to all participants in quantitative survey and all interviewees in qualitative research who spend their precise time to participate in this study.
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This study was supported by the Natural Science Foundation of China Excellent Young Scientists Fund [82022064]. Funders did not have any role in study design or interpretation of data.
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HZ and YS conceived and designed the study in consultation with other authors. YS designed the questionnaire in consultation with YG and HZ. YS conducted the interview and obtained data, and, together with LH, YG, TF and HZ conceived the analysis and presentation. YS, LH, and YG contributed to data analysis and interpretation of data. All authors contributed to interpretation of data and study findings. YS drafted the manuscript with all authors critically reviewing the paper. All authors have read and approved the final report.
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Sun, Y., He, L., Gao, Y. et al. Barriers and Facilitators to, and Experience of, Voluntary Medical Male Circumcision Among Men Who Have Sex with Men in China: A Mixed-Methods Study. Arch Sex Behav 52, 2065–2081 (2023). https://doi.org/10.1007/s10508-023-02634-2
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DOI: https://doi.org/10.1007/s10508-023-02634-2