Acceptability of Medical Male Circumcision Among Uncircumcised Men in Kenya One Year After the Launch of the National Male Circumcision Program Amy Herman-Roloff1,2*, Nixon Otieno2, Kawango Agot3, Jeckoniah Ndinya-Achola4{, Robert C. Bailey1,2 1 Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, United States of America, 2 Nyanza Reproductive Health Society, Kisumu, Kenya, 3 Impact Research and Development Organization, Kisumu, Kenya, 4 Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya Abstract Background: Numerous studies have demonstrated that male circumcision (MC) reduces the incidence of the Type-1 human immunodeficiency virus (HIV) among heterosexual men by at least half. Methods: One year after the launch of a national Voluntary Medical Male Circumcision program in Kenya, this study conducted 12 focus group discussions among uncircumcised men in Nyanza Province to assess the revealed, non- hypothetical, facilitators and barriers to the uptake of MC. Results: The primary barriers to MC uptake included time away from work; culture and religion; possible adverse events; and the post-surgical abstinence period. The primary facilitators of MC uptake included hygiene; social pressure; protection against HIV and other sexually transmitted infections; and improved sexual performance and satisfaction. Conclusions: Some activities which might increase MC uptake include dispelling MC misconceptions; increasing involvement of religious leaders, women’s groups, and peer mobilizers for MC promotion; and increasing the relevance of MC among men who are already practicing an HIV prevention method. Citation: Herman-Roloff A, Otieno N, Agot K, Ndinya-Achola J, Bailey RC (2011) Acceptability of Medical Male Circumcision Among Uncircumcised Men in Kenya One Year After the Launch of the National Male Circumcision Program. PLoS ONE 6(5): e19814. doi:10.1371/journal.pone.0019814 Editor: Andrew D. Badley, Mayo Clinic, United States of America Received January 7, 2011; Accepted April 11, 2011; Published May 16, 2011 Copyright: 2011 Herman-Roloff et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: Support for this study was provided by a grant to FHI from the Bill and Melinda Gates Foundation to support the Male Circumcision Consortium, a partnership between FHI, University of Illinois at Chicago working closely with the Nyanza Reproductive Health Society, and EngenderHealth. The views expressed in this publication do not necessarily reflect those of the Bill and Melinda Gates Foundation or the MCC partners. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: amykateherman@hotmail.com { Deceased. Introduction Male circumcision (MC) is the surgical removal of the foreskin of the penis and is practiced around the world for medical, religious, and cultural reasons. Over 40 observational studies and three randomized controlled trials (RCTs) have established that MC reduces the risk of the Human Immunodeficiency Virus (HIV) Type-1 acquisition in heterosexual men by approximately 60%.[1–4] In 2007, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended that MC, provided by trained professionals, be implemented as one component of a comprehensive HIV prevention strategy in regions with low MC rates, high HIV prevalence, and where heterosexual sex is the mode of transmission.[5] Nyanza Province is the geographic home to the Luo ethnic group, a Niolotic-speaking people with some traditions and customs that differ from the surrounding primarily Bantu-speaking ethnic groups. The Luo people comprise the fourth largest ethnic group in Kenya with a population of approximately four million people.[6] A recent population survey reported that 21.5% of Luo men are circumcised and 17.1% are HIV-positive.[7] The Government of Kenya (GoK) launched the national Voluntary Medical Male Circumcision (VMMC) program in November, 2008, and plans to circumcise 860,000 males by 2013.[8] Currently, the VMMC program provides high-quality, medical MC services throughout Luo districts in Nyanza Province at no cost to clients. Prior to completion of the three RCTs, several studies investigated factors that might facilitate or inhibit uptake of MC. Westercamp and Bailey reviewed 13 MC acceptability studies and concluded that the studies were consistent in identifying certain factors that facilitated MC uptake, including the beliefs that MC leads to improved hygiene, protection from sexually transmitted infections (STIs) and HIV, improved sexual pleasure and performance, and greater acceptability by other ethnic groups. The barriers to uptake most commonly identified were pain, culture and religion, cost, possible adverse events (AEs), and the potential for risk compensation (i.e., an increase in risky sexual behavior following MC).[9] Studies conducted in Nyanza Province reported that the primary reasons men chose circumcision were enhanced protec- PLoS ONE | www.plosone.org 1 May 2011 | Volume 6 | Issue 5 | e19814