Determinants of women's support for voluntary medical male circumcision for HIV prevention in fishing communitiess on shores of lake victoria, Uganda

Abstract

Introduction: Voluntary medical male circumcision (VMMC) is proven to reduce the risk of sexual transmission of HIV from women to men by 60%. Despite the achievements of Uganda’s VMMC rollout, the country has not met its target to attain 80% VMMC coverage. This may be due to the different perspectives and knowledge gap between men and women about the impact of VMMC on HIV prevention. The purpose of this study was to determine the factors associated with women’s support for VMMC in fishing communities on shores of Lake Victoria in order to scale up the uptake of VMMC services in such most high risky populations. Methods: A descriptive cross sectional study utilizing both quantitative and qualitative methods of data collection was employed, involving 313 participants. A semi structured questionnaire for quantitative data was used. Quantitative data was entered, coded in EpiData version 3.02 and analyzed using STATA Version 14.0. A description of demographic characteristics of respondents was presented in a table form. At bivariate level, a chi-square test was used to determine the association between independent variables and women’s support for VMMC. Independent variables that were found to be associated with women’s support for VMMC at bivariate level were included in the multivariate by model modified Poisson regression using back ward elimination method. Qualitative data was analyzed manually by coding the responses into themes. Content analysis was used to come up with emerging themes relevant to the factors associated with women’s support for VMMC. Results: The study findings established that 73.5% of the respondents were in support their partners for VMMC, although 55% of them had circumcised partners. Only 21.6% knew that VMMC can reduce HIV acquisition by 60%. A number of factors were associated with women’s support for VMMC; the prevalence of support for VMMC uptake was 1.9 times higher among women who reported that VMMC increases penile hygiene (Adj. PR=1.90; CI: 1.86-1.97), also the prevalence of support for VMMC was 1.1 times higher among women who reported that health facilities providing VMMC services have adequate health workers (Adj.PR=1.10; 1.00-1.18). While women who had a belief that vaginal fluids facilitate wound healing, their prevalence of support for VMMC was 1.92 times higher compared to those who did not (Adj.PR=1.92; CI: 1.88-1.96).The study further established that women were not involved in any VMMC programme decision making.

Conclusion Among women in fishing communities along Lake Victoria in Uganda, support for VMMC was high. However, most of them were unable to explain the concept of VMMC in relation to HIV risk reduction and did not know the wound healing period of at least 6 months. Women also had misconceptions about VMMC that; vaginal fluids facilitate wound healing. Health workers are not offering post-operative circumcision services to circumcised men. The study also found that women were not involved in VMMC programmes for decision making. Recommendations Health workers offering VMMC services should give explicit information explaining the mechanisms by which VMMC reduces a man’s chances of acquiring HIV infection. The ministry of health and VMMC implementing partners to incorporate women in VMMC programme decision making process to address misconceptions and community held beliefs that influence VMMC uptake. Health workers should also create awareness about wound healing period and address post-operative circumcision follow up gaps to monitor any adverse events.