Background: Voluntary medical male circumcision (VMMC) is an HIV prevention priority. This study aimed to characterize correlates of VMMC acceptability in Zambia in order to identify potential demand-generation mechanisms.
Methods: Data come from a nationally representative survey of individuals aged 15-59 in 14 districts across Zambia''s 10 provinces. Two-stage sampling proportional to population size was used to select households across residence types (urban/rural) in enumeration areas. The primary outcome, VMMC acceptability, was assessed and dichotomized using a single survey item measuring respondent acceptance of VMMC. Independent covariates of interest included socio-demographic factors and other HIV-related factors, including serostatus knowledge. Analytic weights derived from 2010 Zambian census data and 2016 population projections adjusted for clustering and stratification. Following descriptive analysis, bivariate logistic regression analysis was conducted to identify statistically significant associations between independent variables and VMMC. To identify correlates of VMMC acceptability after adjustment, variables reaching a significance threshold of p< 0.05 in bivariate analysis were introduced into a multivariable logistic regression model.
Results: Among 3,532 respondents, 81% (n=2,861) reported acceptance of VMMC, and no significant differences emerged in VMMC acceptability between men and women (77.3% vs. 84.7%, p=0.121). Circumcision coverage among men, however, hovered under 30% (n=517). Female respondents (aOR=1.67, CI: 1.38-2.02) and those in the highest wealth quartile (AOR=1.63, CI: 1.25-2.13) had over 60% higher odds, respectively, of accepting VMMC. Married/partnered participants were 38% less likely to accept VMMC compared to unmarried participants. Among HIV-related factors, HIV knowledge was positively associated with VMMC acceptance (AOR=1.21, CI: 1.16-1.26), while HIV unknown serostatus (AOR=0.63, CI: 0.50-0.80) and stigmatizing attitudes towards people living with HIV (AOR=0.92, CI: 0.87-0.98) were associated with decreased odds of VMMC acceptability.
Conclusions: Moderately low VMMC uptake accompanied high acceptability, suggesting the need to support men in overcoming barriers to VMMC uptake. Findings reveal that those who do not access HIV testing are also not accessing VMMC, highlighting the need to ensure that the voluntary nature of testing at VMMC is clear. Results highlight gaps in VMMC demand among married and lower-income men as well as opportunities further engage women, who exhibited higher acceptability of VMMC than me, for promoting VMMC uptake.

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