Perceptions of, and factors influencing, VMMC decision making among active duty men in Malawi

Abstract

Background Voluntary Medical Male Circumcision (VMMC) plays a vital role in HIV prevention, especially in high-burden regions like sub-Saharan Africa. Despite efforts to promote VMMC uptake, understanding the experiences and factors influencing decision-making, particularly among active duty men in Malawi, remains essential due to persistently low uptake rates. This qualitative study explores the perceptions, understandings and experiences of men regarding VMMC and the factors influencing their decisions to undergo the procedure. Methodology This qualitative study, conducted at the Unique military base* in Lilongwe, Malawi, involved both circumcised and uncircumcised active-duty men. Purposive sampling ensured diversity across marital status, rank, years of service, and age groups. In-depth interviews, conducted in English or Chichewa, explored perceptions and decision-making factors. Thematic analysis, guided by health behaviour theories and inductive coding, was employed to analyse the data. Results Participants were diverse in age, marital status, rank, and years of service. Among the circumcised group, participants ranged in age from 18 to over 50 years old, with varying ranks and years of service. There was a complex interplay of factors influencing VMMC decision-making, including cultural beliefs, peer influence, access to healthcare services, and individual perceptions of risk and benefit. Notably, participants from both circumcised and non-circumcised groups expressed valuable insights into their decision-making processes, highlighting the importance of considering a range of perspectives when designing interventions to promote VMMC uptake. Additionally, the study identified the role of military culture and organizational factors in shaping attitudes towards VMMC, suggesting the need for targeted approaches that address the unique dynamics within military settings. Overall, the findings contribute to a deeper understanding of VMMC decision- making among active duty men in Malawi and provide valuable insights for the development of tailored interventions to increase VMMC uptake in this population. By addressing the diverse needs and preferences of military personnel, public health initiatives can effectively promote VMMC as a key component of HIV prevention efforts, ultimately contributing to improved health outcomes within the military and broader communities. Conclusion In conclusion, this study sheds light on the factors influencing decision-making processes regarding VMMC among active duty men in Malawi. Through a qualitative approach, the research captured diverse perspectives from both circumcised and non-circumcised participants, providing a nuanced understanding of the motivations, perceptions, and barriers related to VMMC uptake within the military context.