Factors Associated with Low Uptake of Voluntary Medical Male Circumcision as HIV-Prevention Strategy among Men Aged 18-49 Years from Nyanza District, Rwanda

Abstract

Background: Voluntary medical male circumcision (VMMC) is an effective biomedical intervention against HIV in developed and developing countries. However, there is low uptake of VMMC due to various factors, which hinders achievement of health-policy goals to increase uptake. Numerous campaigns offering the procedure free of charge exist in developing countries, but such initiatives seem to bear little fruit in attracting men to these services. This study assessed risk factors associated with the low uptake of VMMC among men in Nyanza district, Southern Province, Rwanda.

Methods: A cross-sectional study was conducted among adult males in Nyanza. A total of 438 men participated in individual interviews. Bivariate and multivariate logistic regression models were used with 95% confidence intervals and p≤0.05 was taken as statistically significant.

Results: Our results indicated that a low update of VMMC was highly prevalent (35.8%). A majority (84.7%) of participants had heard about VMMC, its complications, advantages in preventiing penile cancer, sexually transmitted infections, and HIV, condom use after circumcision, abstinence for 6 weeks after circumcision, and improving penile hygiene. Religion and education were significant factors in low uptake. Catholics were less likely to undergo VMMC than Muslims (OR 7.19, 95% CI 1.742-29.659; p=0.01). Those of other faiths were less likely to undergo VMMC than Muslims (OR 6.035, 95% CI 1.731-21.039; p=0.005). Participants with secondary education were less likely to undergo VMMC than those with primary education only (OR 1.4, 95% CI 0.74-2.64; p=0.03). Having no formal education decreased the odds of being uncircumcised (OR 0.37, 95% CI 0.14-0.977; p=0.045) when compared to those with primary education.

Conclusion: Uptake of VMMC remains low in Nyanza, but most men had sufficient knowledge about it. Education, religion, and marital status were major factors in the low uptake. Programs targeting peer influences and parents need to be prioritized.

Keywords: HIV/AIDS; VMMC; adult; low uptake; male circumcision; men; prevention.

Figure 1

Conceptual framework of variables used in this study, ie, independent, intervening and outcome variables. We usedthree classes of independent variables. (A) Sociodemographic variables were age, education, area ofresidence, religion, marital status, and monthly income. (B) Knowledge on VMMC comprised subjects having heard about VMMC, MC complications, abstinence after circumcision, condom use after MC, MC reducing the risk of STIs and penile cancer, and improving penile hygiene. (C) socio-cultural factors and other factors including attitudes and behavior regarding MC (fear of losing foreskin, fear of pain, and stigma). Intervening variables were accessibility of services, availability of services, distance from household to health facility, transport, cost, and recovery period. The outcome variable was low uptake of VMMC.