Enhancers and barriers to uptake of male circumcision services in Northern Uganda: a qualitative study

ABSTRACT

Uganda adopted voluntary medical male circumcision (VMMC) in 2010, but uptake remains disproportionately low in the Northern region despite implementing several demand creation strategies. This study explored the socio-cultural and structural enhancers and barriers to uptake of VMMC services in Gulu, a district in Northern Uganda where uptake is lowest. In September 2016, we conducted 19 focus group discussions, 9 in-depth interviews, and 11 key informant interviews with 149 total participants. Data were collected and analyzed thematically using both inductive and deductive approaches, then framed in four levels of the social ecological model. Enhancers included adequate knowledge about VMMC services, being young and single, partner involvement, peer influence, perceived increased libido after circumcision, and availability of free and high-quality VMMC services. Barriers included sexual abstinence during wound healing, penile appearance after circumcision, religion, culture, and misconceptions. Optimizing enhancers and addressing barriers could increase VMMC service uptake in northern Uganda.

KEYWORDS:

• Male circumcision
• uptake
• facilitators
• challenges

Acknowledgements

We hereby acknowledge support for this work from the National Institutes of Health (NIH) Fogarty International Center (FIC) through the Rakai Health Sciences Program-Uganda and African Doctoral Dissertation Research Fellowship (ADDRF). We thank the supervisors at the Ministry of Health, including Dr. Jane Ruth Acheng, Professor Anthony K. Mbonye, and Dr. Joshua Musinguzi. We also thank Dr. Peter Simon Kibira, who helped review the study protocol especially the methodology. We thank our research assistants, led by Julius Kisenyi, David Makubuya, Brian Ssenoga, Okello James Stewart, Arop Stephen, Abala Julius, Ochan Jesse, Odong Nicky, Akello Irene Olara Emmanuel, Otto Moses Oyika, and Lamunu Winnie. Finally, we thank the Gulu district leaders and all our participants.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institutes of Health (USA) Fogarty International Center under grant award numbers D43TW009578 and D43TW010557 and the African Doctoral Dissertation Research Fellowship (ADDRF).