1. Adolescent Girls’ Support of Male Peers and Sexual Partners Receiving Voluntary Medical Male Circumcision (VMMC) Services: Implications for Demand Creation Authors: Michelle Kaufman 1, Kim Dam 1, Karin Hatzold 2, Lynn Van Lith 1, Gertrude Ncube 3, Gissenge Lija 4, Collen Bonnecwe 5, Webster Mavhu 2, Catherine Kahabuka 6, Kimberly Seifert-Ahanda 7, Arik Marcell 8, Lusanda Mahlasela 9, Maria Elena Figueroa 1, Emmanuel Njeuhmeli 7, and Aaron Tobian 8 for the Adolescent VMMC Technical Advisory Group Photo: Girls in Khayelitsha, South Africa, dance at an open air campaign for an HIV support group. © 2012 Cristi O'Connor, Courtesy of Photoshare

2. BACKGROUND VMMC has reached large number of adolescent males (ages 10-19) in sub- Saharan Africa Little is known about female adolescents’ involvement Qualitative Study: Adolescent girls’ support of their male peers and sexual partners undergoing the procedure in Tanzania, Zimbabwe and South Africa

3. METHODS Adolescent females 16-19 years old 12 FOCUS GROUP DISCUSSION S (FGDs) Adolescent males 10-19 years old 6-8 weeks post-procedure 92 IN DEPTH INTERVIEWS (IDIs)

4. RESULTS: GIRLS’ PREFERENCE “Circumcised males are clean and they are attractive; a person who is uncircumcised carries a lot of infections on his foreskin, he must be very dirty and girls run away from him.” –19 years old female, Makambako, Tanzania Sexual appeal Hygiene Improved sexual performance Reduced chances of infections (including HIV)

5. RESULTS: GIRLS’ INFLUENCE “Yes, I can convince my boyfriend to get circumcised, because when I find out that he is not circumcised I wouldn’t even dare to have sex with him. I will tell him to get circumcised since he can hide a lot of diseases under his foreskin.” –18 years old female, Makambako, Tanzania 'I cannot have sex with you if you’re not circumcised because number 1, I will catch "chirwere" [HIV]. Number 2, cervical cancer. Show me you love me by getting circumcised'. –18 years old female, Mt Darwin, Zimbabwe Supportive of boys’ decision Overt and covert influence

6. RESULTS: GIRLS’ INFLUENCE Girls would be more interested if they got circumcised VMMC as criteria for selecting partners “I have heard some girls saying, 'We now want guys who are circumcised, we no longer want the uncircumcised ones as they may have chirwere [disease, also used to specifically refer to HIV/AIDS] and so on.” – 16 years old circumcised male, Mt Darwin, Zimbabwe “She [my girlfriend] did [motivate me]. She said because all my friends have done it, I should also do it and the pain will be over.” – 13 years old circumcised male, Ermelo, South Africa

7. RESULTS: EMOTIONAL SUPPORT Healing process versus decision making process “Women and girls have a huge contribution because they tell the boys that they cannot have a relationship with an uncircumcised man, so if a man really loves her he has to be circumcised.” – 16 years old female, Mafinga, Tanzania

8. CONCLUSION Adolescent girls are involved in VMMC decision-making, especially with older adolescent boys. Demand creation initiatives should continue to engage females in promoting VMMC to their male counterparts.