Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda

Abstract

BackgroundIn 2010, the Uganda Ministry of Health introduced its Safe Male Circumcision (SMC) strategy for HIV prevention with the goal of providing 4.2 million voluntary medical male circumcisions by 2015. Fishing communities, where HIV prevalence is approximately 3–5 times higher than the national average, have been identified as a key population needing targeted HIV prevention services by the National HIV Prevention Strategy. This study aimed to understand perceptions of HIV and identify potential barriers and facilitators to SMC in fishing communities along Lake Victoria.MethodsWe conducted 8 focus group discussions, stratified by sex and age, with 67 purposefully sampled participants in 4 communities in Kalangala District, Uganda.ResultsThere was universal knowledge of the availability of SMC services, but males reported high uptake in the community while females indicated that it is low. Improved hygiene, disease prevention, and improved sexual performance and desirability were reported facilitators. Barriers included a perceived increase in SMC recipients’ physiological libido, post-surgical abstinence, lost income during convalescence, and lengthier recovery due to occupational hazards. Both males and females reported concerns about spousal fidelity during post-SMC abstinence. Reported misconceptions and community-held cultural beliefs include fear that foreskins are sold after their removal, the belief that a SMC recipient’s first sexual partner after the procedure should not be his spouse, and the belief that vaginal fluids aid circumcision wound healing.ConclusionsPrevious outreach efforts have effectively reached these remote communities, where availability and health benefits of SMC are widely understood. However, community-specific intervention strategies are needed to address the barriers identified in this study. We recommend the development of targeted counseling, outreach, and communication strategies to address barriers, misconceptions, and community-held beliefs. Interventions should also incorporate female partners into the SMC decision-making process and develop compensation strategies to address lost income during SMC recovery.

“Now that you are circumcised, you cannot have first sex with your wife”: post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda

“…This should be a consideration for programme implementers because beliefs of this kind could put some newly circumcised men that adhere to them, as well as their sexual partners at the risk of HIV infection. This belief has also been reported among fishing communities on lake Victoria, Uganda [14,22] and in unpublished work in eastern Uganda [23]. It is also loosely mentioned in a national supervision report for HIV/AIDs activities [24], which may indicate that it is not only limited to this study.…”

Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda

“…Concerns about misunderstanding the level of protection from circumcision have also been reported in southern Africa [52, 53] and among fishing communities in Uganda [27]. Such misconceptions could be due to information from less reliable sources within communities and/or misunderstandings of SMC social marketing messages, as indeed feared by some men in this study.…”

“…Other reasons reported such as better penile hygiene, risk reduction to some STIs and cervical cancer prevention to partners, are also portrayed in SMC messages to the public in Uganda [45, 46]. Studies conducted in other sub Saharan countries [47, 48, 27, 29, 26] have also reported that these reasons play a role in influencing men to circumcise.…”

“…Previous studies have shown that among the most important reasons for deciding to circumcise are the expected benefits in terms of HIV risk reduction, and the influence of women[21–23]. However, these studies have been largely based on community views and male informants who have not yet been circumcised [21, 22, 24–27, 23]. Only a few included self-reports of circumcised men [28–30].…”

Sexual behaviours, awareness and perceptions towards voluntary medical male circumcision among students in Dr Kenneth Kaunda District, South Africa

“…Some observational studies conducted in the field of VMMC have found that men who are circumcised are more likely to engage in risky sexual behaviour than those who are uncircumcised. 15,17,20 In Africa there is a strong belief that circumcision improves sexual performance, especially among adults, and there is also a concern that this can increase the risk of HIV transmission. Equally so, there is a strong believe that the perceptions that communities hold about VMMC can likely affect their sexual behaviours after undergoing the procedure.…”