himself, and is unlikely to have initiated sexual activity.[10,17] In this sample, participants believed that adolescent boys and teenagers were best suited to go for MC (aged 11–18 years). While several governments are targeting sexually active males during the initial phase of implementing a large-scale MC program,[5,8] community opinions about the ideal age for MC should not be ignored. The results of this study might be useful for the development or improvement of a MC communication campaign both within and outside of Kenya. A national or regional communication campaign is well-positioned to dispel misconceptions like the recommended duration of time away from work (usually a few days, but less than one week) versus the recommended abstinence period (six weeks). Additionally, many participants stated that men are concerned about developing severe AEs post-MC. Preliminary results from a study in Kenya found that 2.7% of clients experienced a moderate or severe AE, and all AEs resolved with treatment;[12] low AE rates were also reported by a large-scale MC program in South Africa.[19] The message that medical MC very rarely results in severe, untreatable AEs should be disseminated widely. Finally, participants were hesitant to believe that MC really protects against HIV acquisition because they did not know the mechanisms that explained this protection, and these mechanisms can be communicated through campaign messages. The findings reported above should be considered along with the following study limitations. The results from this study might not be generalizable to other programs and countries since they were restricted to Nyanza Province. Additionally, while purposive sampling was employed in an attempt to recruit a representative sample of uncircumcised men (self-report) aged 18–40 years, it is possible that this study might not describe the full range of beliefs related to MC in Nyanza Province; however, saturation was achieved, and no new themes emerged during the final FGDs conducted within each age category. Also, all participants were uncircumcised with no plans to get circumcised, so their opinions about MC might be more negative than the general population. References 1. Weiss HA, Halperin D, Bailey RC, Hayes RJ, Schmid G, et al. (2008) Male circumcision for HIV prevention: from evidence to action? AIDS 22: 567–74. 2. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2: 11. 3. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, et al. (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 24: 643–56. 4. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, et al. (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 24: 657–66. 5. World Health Organization (2007) New data on male circumcision and HIV prevention: policy and programme implications. Available: http://data.unaids. org/pub/Report/2007/mc_recommendations_en.pdf. Accessed 2010 Dec 1. 6. Kenya National Bureau of Statistics (2009) Population and Housing Census Results. Available: http://www.knbs.or.ke/Census%20Results/Presenta- tion%20by%20Minister%20for%20Planning%20revised.pdf. Accessed 2011 Jan 3. 7. Kenya National Bureau of Statistics and ICF Macro (2010) Kenya Demographic and Health Survey 2008-09. 8. Republic of Kenya, Ministry of Public Health & Sanitation. Kenya National Strategy for Voluntary Medical Male Circumcision. October, 2009. 9. Westercamp N, Bailey RC (2007) Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review. AIDS Behavior 3: 341–355. 10. Bailey RC, Muga R, Poulussen R, Abicht H (2002) The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya. AIDS Care 14: 27–40. Acceptability of Male Circumcision in Kenya Finally, the data collected during this study were self-reported opinions about community perceptions of MC; therefore, it is possible that the participants themselves did not hold these opinions and might have withheld, or exaggerated, information. The results of this study are very consistent with the results of previous studies, but they add a nuanced understanding of revealed – not hypothetical – acceptability of MC services. These results may be used to implement or improve several program activities to positively impact MC uptake, including: revising communication messages to dispel misconceptions; increasing the involvement of religious leaders, women’s groups, and peer mobilizers in MC sensitization; and situating MC within the existing HIV prevention framework (e.g., ABC, HIV testing, home-based counseling and testing, couples testing and counsel- ing, and STI diagnosis and treatment.) to improve the relevance of this intervention for men already practicing some HIV prevention methods. Acknowledgments We thank the Government of Kenya and the study participants without whom this work would not have been possible. We also thank Martin Ajujo, Mark Dworkin, Tim Johnson, Joan Kennelly, Deborah Rosenberg, Nelli Westercamp, and Nyanza Reproduc- tive Health Society research staff for their commitment to the study and comments on this manuscript. Supporting Information Text S1 (DOC) Focus Group Discussion Guide. Author Contributions Conceived and designed the experiments: AH-R NO KA JN-A RCB. Performed the experiments: AH-R NO. Analyzed the data: AH-R NO. Wrote the paper: AH-R. Reviewed manuscript: NO KA JN-A RCB. 11. Mattson CL, Bailey RC, Muga R, Poulussen R, Onyango T (2005) Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya. AIDS Care 17: 182–194. 12. Herman-Roloff A, RBailey, KAgot, Ndinya-Achola J (2010) Medical male circumcision for HIV prevention in Kenya: a study of service provision and adverse events. Vienna: abstract MOPE0336. 13. Westercamp N, RBailey, KAgot, Ndinya-Achola J (2010) Factors associated with the circumcision decision: baseline results from the risk compensation study in Nyanza Province, Kenya. Vienna: abstract MOPE0332. 14. Riess TH, Achieng’ MM, Otieno S, Ndinya-Achola JO, Bailey RC (2010) ‘‘When I Was Circumcised I Was Taught Certain Things’’: Risk Compensation and Protective Sexual Behavior among Circumcised Men in Kisumu, Kenya. PLoS ONE 5: e12366. doi: 10.1371/journal.pone.0012366. 15. Krueger R, Casey M (2000) Focus groups: a practical guide for applied research. Thousand OaksCA: Sage. 16. Miles MB, Huberman AM (1994) Qualitative data analysis: an expanded source book. Thousand OaksCA: Sage. 17. Ngalande RC, Levy J, Kapondo CP, Bailey RC (2006) Acceptability of male circumcision for prevention of HIV infection in Malawi. AIDS Behavior 2006 10: 377–85. 18. Wilcken A, Miiro-Nakayima F, Hizaamu RN, Keil T, Balaba-Byansi D (2010) Male circumcision for HIV prevention – a cross-sectional study on awareness among young people and adults in rural Uganda. BMC Public Health 26: 209. 19. Lissouba P, Taljaard D, Rech D, Doyle S, Shabangu D, et al. (2010) A Model for the Roll-Out of Comprehensive Adult Male Circumcision Services in African Low-Income Settings of High HIV Incidence: The ANRS 12126 Bophelo Pele Project. PLoS Med 7: e1000309. doi:10.1371/journal.pmed.1000309. PLoS ONE | www.plosone.org 6 May 2011 | Volume 6 | Issue 5 | e19814