Multilevel influences on acceptance of medical male circumcision in Rakai District, Uganda

ABSTRACT

Despite access to safe medical male circumcision (MMC) and proven effectiveness of the procedure in reducing acquisition of HIV and other sexually transmitted infections, uptake remains suboptimal in many settings in sub-Saharan Africa, including Rakai District, Uganda. This study explored multilevel barriers and facilitators to MMC in focus group discussions (FGDs) (n = 35 groups) in Rakai. Focus groups were conducted from May through July 2012 with adolescent and adult males, with a range of HIV risk and reproductive health service use profiles, and with adolescent and adult females. Data were analyzed using Atlas.ti and an inductive approach. Participants’ discussions produced several key themes representing multilevel influences that may facilitate or create barriers to uptake of MMC. These include availability of MMC services, economic costs, masculine ideals, religion, and social influence. Understanding how males and females view MMC is a crucial step towards increasing uptake of the procedure and reducing disease transmission.

KEYWORDS:

• Medical male circumcision
• HIV
• sexually transmitted infections
• Uganda

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute of Child Health and Human Development [grant number NICHD RO1 HD070769] and the Bill and Melinda Gates Foundation [grant number 22006.03]. Pamela Lilleston gratefully acknowledges doctoral support through the National Institutes of Health under Ruth L. Kirschstein National Research Service Award T32A1050056 from the National Institute of Allergy and Infectious Diseases.