Provider experiences and opinions on counseling adolescents undergoing voluntary medical male circumcision in western Kenya

Abstract

Objectives: Voluntary medical male circumcision (VMMC) remains an important component of comprehensive HIV prevention package. Kenya and other key countries are focusing increased attention on achieving large proportions of adolescent circumcisions. Because little is known about the impact of adolescent VMMC counseling, we sought to capture the experiences and opinions of VMMC providers regarding effective adolescent VMMC counseling.

Design and Setting: We purposively selected six VMMC sites: three each in Siaya and Kisumu Counties. From each site, we administered key informant interviews to two VMMC providers at a place of their choice for privacy and confidentiality. Outcomes of the study were participant responses to questions regarding their adolescent counseling practices, prior training, and opinions for improvement of counseling practices.

Results: Three providers (25%) reported having been trained on adolescent-specific VMMC counseling. Compared to adults, adolescents receive less information during VMMC counseling. There was lack of consistency in counseling procedures, with counselors making subjective judgments as to what content to include, depending on their perception of the sexual experience of the client. Providers recommended greater engagement of parents in the VMMC process, limiting numbers of clients per day to ensure quality of counseling, and allocation of space to facilitate confidentiality.

Conclusions: All providers counseling adolescent VMMC clients should receive adolescent-specific counseling training, and adhere to national VMMC guidelines. Measures to assure confidentiality should be taken, and numbers of clients per day limited to ensure quality of counseling services.