COVERAGE AND UTILIZATION OF VOLUNTARY MEDICAL MALE CIRCUMCISION FOR HIV PREVENTION IN FISHING COMMUNITIES IN KIGOROBYA SUB-COUNTY, HOIMA DISTRICT

Abstract

Background. In Uganda, only 40% of men are circumcised yet SMC for HIV prevention was introduced in 2010 after randomized trials showed that it reduces HIV acquisition in males by 60%. Coverage and utilization of male circumcision services is important to assess progress especially among high risk groups such as the fisher folks. Objective: To determine the coverage and factors associated with utilization of voluntary medical male circumcision services so that interventions could be designed to improve service utilization among the fisher folks at Kigorobya sub-county. Methods This was a cross sectional study using both quantitative and qualitative methods conducted at Kigorobya sub County. The study had envisaged to recruit 503 respondents, however for reasons that were not disclosed to the PI, five respondents declined to participate in the study leaving a total of 498 respondents who participated in the quantitative part of the study. Structured interviewer administered questionnaires were used to collect quantitative data while FGD guides and KII guides were used to collect qualitative data. Univariate analysis was done for descriptive characteristics. Modified Poisson regression model was used to estimate prevalence ratios of VMMC and their respective 95% confidence intervals, and to identify associated factors. Quantitative data was analyzed using Stata version 13 while qualitative data was analyzed manually using a master sheet. Results The mean (SD) and median (IQR) age in years of participants were 32 (10.8), and 15 (24-39) respectively. Majority (55%) had stopped in primary school, 54% were Protestants, 39% were Roman Catholics and 67% were married. The coverage of VMMC was 54%. Factors associated with increased prevalence of circumcision were education (Adj.PR=1.48; 95% CI:1.03-2.13), marital status (Adj.PR=1.23; 95% CI: 1.03-1.47), occupation (Adj.PR=1.30; 95% CI: 1.01-1.67), partner encouragement (Adj.PR=0.26; 95% CI: 0.09-0.79), health worker friendliness x

(Adj.PR=0.53; 95% CI: 0.44-0.65), and safety of the procedure (Adj.PR=0.57; 95% CI: 0.400.81). While factors associated with reduced prevalence of circumcision were being less than 39 yrs., and not knowing where VMMC services are offered (Adj.PR=1.01; 95% CI: 0.82-1.26). Qualitatively, lack of services, myths and misconceptions, period of time before resuming sex or work and fear of HIV test were the major hindering factors to VMMC utilization. Conclusion:Coverage ofVMMC was 54%. this community is still low. Partner encouragement, health worker friendliness and safety of the procedure are important factors in the utilization of VMMC services. Recommendations: Behavior change communication strategies should address myths and misconceptions about VMMC and should encourage formation of peer groups. Health worker training and supervision is critical in the promotion of circumcision in the sub county.