Page 142 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 7 Original Research

15–29 years. This is also in line with the UNAIDS 90-90-90 Population
strategy to combat the HIV/AIDS pandemic, and the ultimate The targeted population was about 12 710 students in Ndola
elimination of new HIV infections by 2030. 6
district. The sample comprised students from Ndola College
of Biomedical Sciences, Zambia Information Communication
The scale-up of VMMC in Zambia is constrained by the low and Technology College, Northern Technical College, Zambia
3
demand for MC services, especially from young men. Electricity Supply Company (ZESCO) Training Centre and
Studies conducted in sub-Saharan Africa and other parts of the Copperbelt University Ndola Campus.
the world have suggested various barriers to seeking VMMC
services. Studies have suggested that gaps in knowledge
regarding VMMC services, misconception, myths and Setting
negative influences from different sources such as the Ndola is the third largest city in Zambia, with a population
community and families affect the acceptability of VMMC. 7,8,9 of 451 246. It is the industrial and commercial centre of the
Confusion of VMMC with female genital mutilation, fear of Copperbelt, Zambia’s copper-mining region, and capital of
pain, cultural and religious beliefs, cost, the risk of medical Copperbelt Province. Nearly half (49.4%) of the population
complications and adverse effects, and the possibilities that are men and the majority (223 020; 58.4%) are aged 15–64
MC would result in increased sexual risk behaviours or years. The youth (15–24 years) represents 23.5% of the urban
behavioural disinhibitions all influence VMMC uptake rates. population, while the overall median age is 18.5 years.
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Other barriers and risks include the lack of regular access or
no access to healthcare at all, expected time away from
employment in order to heal, lack of spousal support, a Sample size and sampling procedure
reduction in penile sensitivity and size, and fear of a lessened To estimate the knowledge of VMMC among the students
capacity to engage in sexual intercourse. 10,11,12 with a 95% confidence level, and assuming a prevalence of
95% ± 4%, using Kirsh’s (1965) method of sample size
To date, few studies in Zambia have been conducted to calculation, the minimum required sample size was 115. We
determine the MC status and identify predictive factors obtained a sample size of 176 after adjusting for a non-
associated with VMMC uptake among male college youth. response rate of 35%. We assumed uniform design effect
A study conducted in one college in Mansa district, a rural across the colleges as the targeted colleges were in the same
part of Zambia, found that respondents ranked enhanced district and within a 5 km radius of each other.
sexual performance and pleasure as the most important reason
why they would choose circumcision. Almost all (97%, We introduced the study to the heads of institutions or
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N = 25) male respondents thought that loss of penile sensitivity departments at each of the colleges, who then went on to
was beneficial because it allowed both men and women to formally announce the study to their respective student bodies.
enjoy sex for longer periods. However, this study sampled Students who fulfilled the inclusion criteria (male, aged 18–35
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from a non-circumcising community, and the lack of variability years) were approached in their lecture halls typically at the
in sociodemographic characteristics among participants, end of their lectures and asked if they would like to participate
limited the investigators’ ability to make comparisons across in the study. Respondents who met the inclusion criteria were
traditionally circumcising and non-circumcising communities. enrolled regardless of the year of study or HIV status. Students
Factors associated with VMMC uptake may differ between who did not consent to participate in the study were excluded.
rural and urban areas. Thus, we conducted a study targeting We did not expect differences to occur in characteristics
male college and university students aged 18–35 years in an between those who consented to participate in the study and
urban setting in order to determine attitudes and knowledge those who refused as only those that fitted the same recruitment
levels around MC, as well as to explore sociocultural factors criteria were approached for consent. The number of
that influence young men to elect for VMMC services. respondents recruited at each study site was obtained using
the probability proportional to size approach.
Methods
Study design Data collection

A cross-sectional survey study was conducted to determine We administered a standardised questionnaire to eligible
the prevalence and correlates of MC uptake among males participants through in-person interviews. The questionnaire
aged 18–35 years. This study design was preferred to a was piloted on five students at one college in order to improve
mixed-methods study because there was inadequate time to the reliability and validity of the questionnaire. The data
conduct the extensive follow-up required for a cohort study collection instrument consisted of three sections: the
or focus group discussions (FGDs), as students were time- participant’s sociodemographic characteristics, knowledge
constrained because of full course loads. about VMMC and attitudes towards VMMC as a prevention
strategy against HIV transmission. In this study, our outcome
Timeframe variable was the reported MC status among college
youth. We collected data on exposure variables such as
The study was conducted within a duration of 1 month, from demographics (age, marital status, religion, year of study and
02 to 27 May 2016. ethnicity/tribe), knowledge (awareness about medical MC

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