Factors influencing voluntary medical male circumcision uptake and the role of intimate partners in nomadic community of Karamoja sub-region, Uganda

Abstract

Background: Voluntary Medical Male Circumcision (VMMC) is a proven HIV prevention strategy, yet uptake remains low (<20%) among nomadic men in Uganda's Karamoja subregion, hindering national targets of 90% coverage. This study assessed factors influencing VMMC uptake and the role of intimate partners in decision-making.

Methods: A cross-sectional study was conducted among 371 men aged 18-54 years, randomly sampled from men seeking health care at outpatient departments of six facilities that provide medical male circumcision service. Uptake of medical male circumcision was defined as being circumcised medically and willingness to take-up service when available among the non-circumcised men. Men responded to structured questions for quantitative data that captured socio-demographics, circumcision status among others. The data were analyzed using descriptive statistics, chi-square tests, and modified Poisson regression for adjusted prevalence ratios (PR) with 95% confidence intervals (CI). In-depth interviews with 35 purposively selected married women explored intimate partner actions on decision making by men and influencing factors. Thematic inductive analysis was done and results presented in two main themes: Intimate partner actions and factors influencing actions. Convergent discussion done for findings. Results: The mean age of men was 31.61(SD 9.29), and most men resided in rural areas (60.11%, 223) and were married (69.54%, 258). Mean age of women was 28.03(SD 6.40), and were married for mean duration of 7.89 years (SD 5.15) with majority being peasant farmers (54.28%, 19). Overall circumcision uptake was 45.3%(n=168) and Medical male circumcision prevalence was 38.27%(n=142), with 32.35% (66/204) of uncircumcised men reporting willingness. Factors independently associated with low uptake of circumcision were: older age, Jie and Thur ethnicity, significant fears about procedure complications, and 1-2-hour travel duration to VMMC site. While enabling factors were education, previously married, having circumcised friends, reported partner influence, and service availability. Intimate partner actions include encouragement, polite persuasion, and discouragement. These are influenced by knowledge, socio-cultural factors, barriers (myth and misconceptions) and health services factors. Conclusion: Uptake of 45.3% signals progress but underscores socio-cultural, intimate partner actions and systemic access barriers in nomadic contexts, necessitating equitable services to address disparities in marginalized agro-pastoralist communities. While targeting key stakeholders in accelerating VMMC uptake.