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

Abstract

Joan Tusabe,1 Herbert Muyinda,2 Joanita Nangendo,3 Doris Kwesiga,4 Sherifah Nabikande,4 Michael Muhoozi,1 Winnie Agwang,4 Tom Okello,3 Elizeus Rutebemberwa4 1Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda; 2Child Health and Development Center, School of Medicine Makerere University, Kampala, Uganda; 3Clinical epidemiology Unit, School of Medicine, Makerere University, Kampala, Uganda; 4Department of Health Policy, Planning and Management, School of public health, Makerere University, Kampala, UgandaCorrespondence: Joan Tusabe, Email [email protected]: 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.Keywords: voluntary medical male circumcision, men aged 18– 49 years, Western Uganda

Keywords

• voluntary medical male circumcision
• men aged 18-49 years
• western uganda