Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda

Abstract

IntroductionAbout 2.5 million men have voluntarily been circumcised since Uganda started implementing the WHO recommendation to scale up safe male circumcision to reduce HIV transmission. This study sought to understand what influences men's circumcision decisions, their experiences with health education at health facilities and their knowledge of partial HIV risk reduction in Wakiso district.MethodsData were collected in May and June 2015 at five public health facilities in Wakiso District. Twenty-five in-depth interviews were held with adult safe male circumcision clients. Data were analysed using thematic network analysis.FindingsSafe male circumcision decisions were mainly influenced by sexual partners, a perceived need to reduce the risk of HIV/STIs, community pressure and other benefits like hygiene. Sexual partners directly requested men to circumcise or indirectly influenced them in varied ways. Health education at facilities mainly focused on the surgical procedure, circumcision benefits especially HIV risk reduction, wound care and time to resumption of sex, with less focus on post-circumcision sexual behaviour. Five men reported no health education. All men reported that circumcision only reduces and does not eliminate HIV risk, and could mention ways it protects, although some extended the benefit to direct protection for women and prevention of other STIs. Five men thought social marketing messages were ‘misleading’ and feared risk compensation within the community.ConclusionsParticipants reported positive community perception about safe male circumcision campaigns, influencing men to seek services and enabling female partners to impact this decision-making process. However, there seemed to be gaps in safe male circumcision health education, although all participants correctly understood that circumcision offers only partial protection from HIV. Standard health education procedures, if followed at health facilities offering safe male circumcision, would ensure all clients are well informed, especially about post-circumcision sexual behaviour that is key to prevention of risk compensation.

Zulu Men’s Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa

“…A study by L'Engle et al (2014) showed that men had a good understanding of the partial protection offered by VMMC as these participants were able to describe how circumcision reduced HIV transmission and the intention to use other HIV protective measures such as practicing safe sexual intercourse. Similar findings were reported in a later study by Kibira et al (2017). The difference in such findings may be attributed to the levels of education among interviewed participants, the general practice of circumcision, and the cultural context.…”

Factors Influencing the Uptake of Voluntary Medical Male Circumcision Among Boda-Boda Riders Aged 18-49 Years in Hoima, Western Uganda

“…The ndings further show that improved knowledge of the importance for personal hygiene and protection from HIV and other STIs were facilitators for VMMC. Other studies have shown comparable levels of knowledge of health bene ts of VMMC between the general population and a key population of boda-boda riders [24,33]. However, we found varied incorrect information regarding VMMC.…”

“…Where inconsistences existed during analysis, consensus was reached in meetings with all the other research team members. Thematic content analysis following prior themes from similar studies was applied [9,10,12,[23][24][25].…”

“Now that you are circumcised, you cannot have first sex with your wife”: post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda

“…Although we did not intend to stratify selection of participants by age, younger (below 25 years of age) and older participants were evenly represented. The drivers of the circumcision decisions of these men are discussed in a related paper [ 17 ]. The upper age limit (59 years) is in line with AIDS indicator survey age group while the lower age limit (18 years) is the adult age of consent in Uganda.…”