Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice

Abstract

Local beliefs and practices about voluntary medical male circumcision (VMMC) may influence uptake and effectiveness. Data were gathered through interviews with 40 people from four ethnically mixed fishing communities in Uganda. Some men believed that wound healing could be promoted by contact with vaginal fluids while sex with non-regular partners could chase away spirits - practices which encouraged unsafe sexual practices. Information given by providers stressed that VMMC did not afford complete protection from sexually-transmitted infections, however, a number of male community members held the view that they were fully protected once circumcised. Both men and women said that VMMC was good not just for HIV prevention but also as a way of maintaining hygiene among the men. The implementation of VMMC in high-HIV prevalence settings needs to take account of local beliefs about circumcision, working with local religious/social group leaders, women and peers in the roll-out of the intervention.

“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 This belief has also been reported among fishing communities on lake Victoria, Uganda [14,22] and in unpublished work in eastern Uganda [23].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.…”

“…Such fears have also been reported by community members in a study in Tanzania [31]. Another reported belief related to healing was that vaginal fluids accelerate wound healing, which has also been reported in other areas of Uganda recently [14,22,23]. No man in this study reported engaging in early sex resumption for this purpose, but such misconceptions should not be ignored in SMC promotion messages to the general public.…”

“…There is a dearth of published studies about beliefs among SMC clients in programme settings in Uganda. One recent study in fishing communities on Lake Victoria provides some insights from clients [14]. Cultural beliefs regarding circumcision may vary in different settings and could change over time as information from SMC programmes continues to be widely disseminated.…”

HIV-1 transmission networks in high risk fishing communities on the shores of Lake Victoria in Uganda: A phylogenetic and epidemiological approach

“…Most recent data from a baseline sero-survey in 2014 from 12 fishing communities across Lake Victoria in Uganda found that SMC uptake among adults in fishing communities at baseline was between 41% and 66% (higher than 21% reported in Rakai fishing community) [46]. However, recent findings from a qualitative study on the uptake of SMC in our own study area point to continued barriers to uptake of SMC which need to be addressed if coverage is to increase [46]. While ART coverage in many fishing communities remains low (Rakai 13% in men vs 18% in women) or unknown [47].…”

Personal Factors Affecting the Uptake of Voluntary Medical Male Circumcision among Sexually Active Male Populations in Busia County, Kenya

“…It is imperative therefore that campaign strategists include in their messages such males who could lack a motivator to circumcise because they practice safe sex by emphasizing other benefits of VMMC such as improved sexual performance, hygiene and prevention of STIs among other benefits. Most respondents at 78.7% were in agreement that if one practiced unsafe sex they needed to undertake VMMC with 65.1% strongly agreeing and 13.7% simply agreeing (Table 2) According to (Mbonye, Kuteesa, Seeley, Levin, Weiss, & Kamali, 2016) VMMC in a number of African countries is being scaled up as a means to provide partial HIV protection which could be a reason why most respondents would vouch for VMMC especially where they engaged in unsafe sex. Communication messages need to clearly outline that undertaking VMMC doesn't guarantee complete protection against HIV/AIDS and other sexually transmitted diseases.…”