Sexual Risk Behaviours and Willingness to Be Circumcised among Uncircumcised Adult Men in Uganda

Abstract

BackgroundThere has been substantial demand for safe male circumcision (SMC) in Uganda in the early programme scale-up phase. Research indicates that early adopters of new interventions often differ from later adopters in relation to a range of behaviours. However, there is limited knowledge about the risk profile of men who were willing to be circumcised at the time of launching the SMC programme, i.e., potential early adopters, compared to those who were reluctant. The aim of this study was to address this gap to provide indications on whether it is likely that potential early adopters of male circumcision were more in need of this new prevention measure than others.MethodsData were from the 2011 Uganda AIDS Indictor Survey (UAIS), with a nationally representative sample of men 15 to 59 years. The analysis was based on generalized linear models, obtaining prevalence risk ratios (PRR) with 95% confidence intervals (CI) as measures of association between willingness to be circumcised and multiple sexual partners, transactional sex, non-marital sex and non-use of condoms at last non-marital sex.ResultsOf the 5,776 men in the survey, 44% expressed willingness to be circumcised. Willingness to be circumcised was higher among the younger, urban and educated men. In the unadjusted analyses, all the sexual risk behaviours were associated with willingness to be circumcised, while in the adjusted analysis, non-marital sex (Adj PRR 1.27; CI: 1.16–1.40) and non-use of condoms at last such sex (Adj PRR 1.18; CI: 1.07–1.29) were associated with higher willingness to be circumcised.ConclusionWillingness to be circumcised was relatively high at the launch of the SMC programme and was more common among uncircumcised men reporting sexual risk behaviours. This indicates that the early adopters of SMC were likely to be in particular need of such additional HIV protective measures.

Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda

“…Instead, subsequent sexual risk behaviors could be driven by other factors such as already prevailing behavior, residence in a fishing community, and low exposure to targeted messaging, as shown in Supplemental Table 1 and Supplemental Table 2. Our findings are also in contrast with some other studies in Uganda 10,11 and other settings 13,23 that found an association. Although one of these studies explicitly reported that circumcised men had higher prevalence of sexual risk behaviors, they observed that majority of these men were HIV negative.…”

“…This is in contrast to findings in a cross-sectional study from the 2011 Uganda AIDS Indicator Survey by Kibira et al which suggested that early adopters of circumcision probably did so because they were already engaging in some sexual risk behaviors. 23 Due to this concern, we controlled for baseline sexual risk behavior in the final models although we had found no association with exposure status (circumcision or uncircumcised). It is important to note that that particular study considered perceived risk for HIV but not the actual HIV status of men.…”

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

“…Circumcision prevalence among men 15 to 49 years in Uganda was 27% in 2011 [17], but with high levels of willingness to be circumcised among uncircumcised men [18]. Those who expressed willingness at the time also seemed to be the ones with the largest need for protective measures [18].…”

“…Those who expressed willingness at the time also seemed to be the ones with the largest need for protective measures [18]. SMC has since been promoted using mass media, posters, billboards, and automobiles with loudspeakers that drive through communities, especially when outreach services are planned.…”

Voluntary Medical Male Circumcision and Sexual Practices among Sexually Active Circumcised Men in Mzuzu, Malawi: A Cross-Sectional Study

“…(Table 7) On transactional sex, age, marital status, location and occupation were significantly associated with engaging in transaction sex. The odds of being involved in transactional sex among those aged [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] was 81% less compared to those aged 18-29 (OR 0.19, 95% CI 0.09, 0.37 p <0.0001). The odds of being involved in transaction sex among the married ones was 88% less compared to those that were single (OR 0.12, 95% CI 0.07, 0.22 p <0.0001).…”