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Advances in Social Sciences Research Journal (ASSRJ) Vol.7, Issue 6, June-2020

pain and disruption of economic engagements. The study concurs that

the health belief model is crucial for the development of audience- focused health communication and recommends its use in VMMC

programme to produce targeted messages for different audience

segments.

Key Words: Perceptions, Disease, Interventions, “Significant Others”,

Communication. Male Circumcision

INTRODUCTION

The Human Immunodeficiency Virus (HIV) remains one of the most perturbing epidemics globally.

At the close of 2018, up to 37.9 million people were living with HIV globally, and 32.0 million people

had died from the Acquired Immune Deficiency Syndrome (AIDS)-related illnesses since the

emergence of the epidemic in the 1980s [1]. The sub-Saharan Africa bears the heaviest burden of

the scourge accounting for over 54 percent of the world HIV infections today. Kenya ranks among

the world’s highest HIV burden countries, with about 1.6 million people in the country living with

HIV and about 46,000 new infections across all ages in 2018 [2]. The epidemic is geographically

diverse, ranging from a high prevalence of 21 percent in Siaya, 20.7 percent in Homa Bay, 16.3

percent in Kisumu and 13.3% in Migori – all in the Lake Victoria region of western Kenya, to a low

prevalence of 0.8 percent in Garissa, 0.2 percent percent in Mandera and 0.1 percent in Wajir

respectively – all in Kenya’s north eastern region [3]. Epidemiological trends show that the

communities that eschew male circumcision have borne the heaviest HIV burden and vice versa [4].

Thus, in light of substantial evidence that male circumcision significantly reduces a man’s risk of

acquiring HIV during sex and developing penile cancer [5, 6], and further proof that male

circumcision is capable of protecting women against a number of sex-related diseases, Kenya

launched the voluntary medical male circumcision (VMMC) for HIV Prevention programme in 2008

[7]. Regions with the highest prevalence of uncircumcised adult males, which also had the highest

HIV prevalence, became the priority regions for the implementation of VMMC [4], Siaya County was

one of them. At 21.0 percent, the county leads in HIV/AIDS prevalence, far above the national

prevalence at of 4.9 percent [3]. The county is found in the Lake Victoria region of western Kenya,

and is predominantly inhabited by the traditionally non-circumcising Luo community. It is

estimated that nearly half of all uncircumcised men are found in this region, where circumcision

prevalence is only 48.2 percent against the national average of 85 percent [3].

However, while VMMC was embraced as a significant addition to the broader HIV/AIDS prevention

and treatment continuum, scholars and policy analysts were quick to warn that the success of the

programme would not be easy to achieve because of the strong beliefs and rituals attached to the

practice particularly among the traditionally non-circumcising communities [8; 9]. Bailey, Moses

and Plummer (8) warned then that studies are just beginning, with significant contradicting

findings, to focus on the biological mechanisms by which the foreskin may increase HIV

susceptibility. Moreover, being circumcised is not a shield from HIV infection, since in some

communities, circumcision rituals subtly encourage new initiates to seek sexual encounters as proof

of their manhood. In other communities, women are encouraged to secretly consider bearing at

least one child from an extra-marital affair, to spread the genes for family survival. These complex

cultural norms and values are not always in the public domain and therefore are hard to stamp out.

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URL: http://dx.doi.org/10.14738/assrj.76.8390 372

Otteng, O., Wenje, P., Kiptoo, M., Anyonje, L., & Mwangi, M. (2020). Using The Health Belief Model To Identify Communication Needs In The Male

Circumcision Campaigns To Prevent Hiv/Aids In Siaya County Of Kenya. Advances in Social Sciences Research Journal, 7(6) 370-388.

It is thus argued [8, 9] that if VMMC is to be promoted, it should be done in a culturally appropriate

manner and people should be provided with sufficient and correct information on HIV and any

intervention against it. These considerations and others in relation to the AIDS response, including

the fact that male circumcision has the potential to be an expensive intervention, that more research

is needed to address whether male circumcision reduces risk of transmitting HIV-particularly for

female partners, and the different ethical and human rights issues raised by male circumcision,

make a well thought out communication programmes with the potential to carry the intended

audience along, an inevitable component of the VMMC. As observed by the UNAIDS in its guidance

for decision-makers on human rights, ethical and legal considerations on safe, voluntary, informed

male circumcision and comprehensive HIV prevention programming, male circumcision is a

complicated issue which involves sometimes difficult discussion on issues of culture, tradition,

religion, ethnicity, human rights and gender. To achieve this, a well thought out interpersonal dyadic

engagement that engenders proper and unambiguous understanding of the target beneficiaries and

other stakeholders by those engaged in developing communication strategies. Perception of a

disease can determine the ways a targeted clients view an intended intervention [10]. Particularly,

individual or community-wide beliefs about HIV as a chronic disease can influence the self-care

strategies used in response to HIV-related symptoms, which are linked to patients’ health outcomes

11]. One pathway to soaring up the uptake of the voluntary make circumcision among the non- circumcising Luo community living in Siaya may be through understanding the perceptions of their

risk HIV and the extent to which they view HIV as a health priority. Previous research on VMMC in

Kenya and in Siaya has dictated much attention to the effectiveness of communication and has not

fully examined the extent to which the intended beneficiaries especially the men who are eligible

for the cut and what Dutta-Bergman [12] calls their “significant others.”

The Health Belief Model

The relationship between health beliefs and behaviours was conceptualised primarily in Lewin’s

[13] idea of ‘valence’, the degree that an individual, activity or object has as a behavioural goal; a

one-dimensional value assigned to an object, situation, or state that can usually be positive or

negative. Particular beliefs were thought to make behaviours more or less attractive. This resulted

in an expectancy-value model of belief–behaviour relationships in which events were positively or

negatively evaluated on the basis of their expected good or bad outcome. In particular, the likelihood

of experiencing a health problem, the severity of the consequences of that problem, and the

perceived benefits of a preventive behaviour, in combination with its potential costs, were seen as

key beliefs that shaped health-related behaviour patterns. Early research found that these health

beliefs were indeed correlated with differences in health-related behaviour patterns and so could

be used to differentiate between those who did and did not undertake such behaviours. The model

was initially applied to preventive behaviours but later extended to identify the correlates of health

service usage and adherence to medical advice [14].

The health belief model is founded on six key components: severity, susceptibility, benefits, barriers,

cues to action, and self-efficacy [12]. It suggests that one’s behaviour can be predicted on the basis

of how vulnerable one believes one is. The HBM vulnerability through risk (perceived susceptibility)

and seriousness of the consequence (perceived severity). The two variables, according Corcoran

[15], should be considered before a decision is taken. This means one has to weigh up the cost and

benefit (pros and cons) of performing a behaviour [16], including how susceptible one feels one is

to contracting an illness, such as HIV and how severe the consequences of having HIV are. While the