Impact of Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision on Knowledge and Sexual Intentions

Background. Little is known regarding the impact of counseling delivered during voluntary medical male circumcision (VMMC) services on adolescents' human immunodeficiency virus (HIV) knowledge, VMMC knowledge, or post-VMMC preventive sexual intentions. This study assessed the effect of counseling on knowledge and intentions. Methods. Surveys were conducted with 1293 adolescent clients in 3 countries (South Africa, n = 299; Tanzania, n = 498; Zimbabwe, n = 496). Adolescents were assessed on HIV and VMMC knowledge-based items before receiving VMMC preprocedure counseling and at a follow-up survey approximately 10 days postprocedure. Sexually active adolescents were asked about their sexual intentions in the follow-up survey. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated by modified Poisson regression models with generalized estimating equations and robust variance estimators. Results. Regarding post-VMMC HIV prevention knowledge, older adolescents were significantly more likely than younger adolescents to know that a male should use condoms (age 10-14 years, 41.1%; 15-19 years, 84.2%; aPR, 1.38 [95% CI, 1.19-1.60]), have fewer sex partners (age 10-14 years, 8.1%; age 15-19 years, 24.5%; aPR, 2.10 [95% CI, 1.30-3.39]), and be faithful to one partner (age 10-14 years, 5.7%; age 15-19 years, 23.2%; aPR, 2.79 [95% CI, 1.97-3.97]) to further protect himself from HIV. Older adolescents demonstrated greater improvement in knowledge in most categories, differences that were significant for questions regarding number of sex partners (aPR, 2.01 [95% CI, 1.18-3.44]) and faithfulness to one partner post-VMMC (aPR, 3.28 [95% CI, 2.22-4.86]). However, prevention knowledge levels overall and HIV risk reduction sexual intentions among sexually active adolescents were notably low, especially given that adolescents had been counseled only 7-10 days prior. Conclusions. Adolescent VMMC counseling needs to be improved to increase knowledge and postprocedure preventive sexual intentions.