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

Abstract

Introduction We asseSssed factors influencing the uptake of voluntary medical male circumcision (VMMC) among boda-boda riders aged 18–49 years in Hoima, western Uganda. Despite high levels of awareness about availability and benefits of VMMC, uptake was still low. Methods We employed the convergent parallel mixed methods design among boda-boda riders in Hoima district between August and September 2020. We administered a structured questionnaire to 316 boda-boda riders to determine factors associated with uptake of VMMC. We also conducted eight focus group discussions (FGDs) and six key informant interviews (KIIs) to explore perceptions of VMMC. To determine factors associated with VMMC, we conducted modified Poisson regression analysis at 5% level of significance. We identified sociocultural barriers and facilitators for VMMC using thematic content analysis. Results Uptake of VMMC was at 33.9% (95% CI 28.6–39.1) and was associated with higher level of education, adjusted prevalence ratio (APR) 1.63, (95% CI 1.12–2.40); concern about being away from work, APR 0.66 (95% CI 0.49–0.88); and the belief that VMMC does not diminish sexual performance, APR 1.78 (95% CI 1.08–2.9). Facilitators of uptake of VMMC were health education and awareness creation, improved penile hygiene, and perceived sexual functioning; and reduced chances of HIV and sexually transmitted infections (STIs). On the other hand, the barriers to uptake were fear of pain and compulsory HIV testing, healing duration, financial loss during the healing period, fear of sexual misbehavior after circumcision, interruption of God’s creation, and fear of loss of male fertility. Conclusion Although VMMC is largely perceived as protective against HIV and other STIs, deliberate measures using multiple strategies should be put in place to address the barriers to its uptake among this key population.

What role do community-level factors play in HIV self-testing uptake, linkage to services and HIV-related outcomes? A mixed methods study of community-led HIV self-testing programmes in rural Zimbabwe

“…In the trial within which this study was nested, we found similar outcomes between the community-led and the paid distributor arms; linkage outcomes and reports of new HIV diagnosis in the intervention arm were comparable with those using a paid distributor model [18], showing communities were able to develop models that worked for them and optimised outcomes. Our process evaluation data (not presented here) suggests barriers to linkage to post-test services some of which have been reported in other studies; the belief that linkage to post-test services is unnecessary for HIV negative people [29,30,31], poor or inaccurate knowledge of PrEP [31,32,33,34] and VMMC [35,36], fear of pain during the VMMC procedure [35,36,37] and long distances to health facilities [38]. Finally, healthcare workers shared the view that linkage works better if they are incentivised for each client linking to services [39]; incentives were not provided in this study.…”

Effectiveness of an intervention to increase uptake of voluntary medical male circumcision among men with sexually transmitted infections in Malawi: a preinterventional and postinterventional study

“…For instance, older age6 44 and younger age,12 45 and being employed46 or unemployed44 have been associated with increased VMMC uptake. Sociodemographic factors that have consistently predicted VMMC uptake include higher education (secondary school and above),10 12 46 belief of improved sexual performance10 12 47 and having two or more sexual partners or high self-perceived risk of HIV 12 14 45. Other factors reported include culture/ethnicity (tribes such as Shona,48 Yao49), religion (being Muslim49), higher socioeconomic status and geographical location (urban areas) 49.…”

“…[6][7][8] Facilitators include perceived health benefits, specifically penile hygiene and reduced risk of HIV and sexually transmitted infection (STI) acquisition, 5 enhanced sexual performance and sexual pleasure among partners of circumcised men, 5 peer or partner pressure, 9 need for social or cultural conformity 9 and advice from health personnel. 9 Additional facilitators reported by other researchers include awareness or knowledge, 10 personal VMMC experiences, 11 and formal education. 12 In addition to the barriers and facilitators, several associated/predictor factors of circumcision have been reported in Malawi.…”

“…These include unemployment,13 being married13 or of younger age,6 exposure to VMMC messages13 and knowledge about VMMC benefits VMMC,13 culture,6 residing in rural areas13 and perceived risk of HIV acquisition 13. Some factors reported elsewhere are higher education,10 12 belief of increased sexual performance,10 12 having multiple partners,12 high perceived risk of HIV/STI acquisition,14 and high exposure to VMMC education/messages 14…”

Shifting reasons for older men remaining uncircumcised: Findings from a pre- and post-demand creation intervention among men aged 25–39 years in western Kenya

“…Specifically, a study conducted in 2019 to investigate the attitudes and key challenges to VMMC adoption found that panic, perceived surgical complications, cost in accessing VMMC services, and involvement of female health workers in the circumcision team, were some of the barriers to VMMC uptake among men in Malawi [66]. Tusabe, et al, [67] in a study conducted in 2020, found that fear of pain and compulsory HIV testing, long healing time, financial constraints, perceived interruption of God's plan, loss of male fertility and involvement of female health workers were barriers to VMMC. Another study also conducted in 2020 in Namibia, found that myths and misconceptions attached to VMMC, age limitations, fear of pain and stigma associated with HIV, and long distances from health facilities negatively impacted VMMC uptake [68].…”