title: Contextual barriers and motivators to adult male medical circumcision in Rakai, Uganda.
abstract: Medical male circumcision (MMC) is a central component of HIV prevention. In this study we examined barriers to and facilitators of MMC in Rakai, Uganda. Interviews and focus groups with MMC acceptors, decliners, and community members were collected and analyzed iteratively. Themes were developed based on immersion, repeated reading, sorting, and coding of data using grounded theory. Pain, medical complications, infertility, lack of empirical efficacy, waiting time before resumption of sex, and religion were identified as obstacles to MMC acceptance. Prevention and healing of sexually transmitted infections (STIs), access to HIV and other ancillary care, penile hygiene, and peer influence were key motivators. Voluntary counseling and testing for HIV, partner influence, and sexual potency were both barriers and motivators. Individual and societal factors, such as pain and religion, might slow MMC scale up. Health benefits, such as HIV/STI prevention and penile hygiene, are essential in motivating men to accept MMC.
authors.affiliation: Rakai Health Sciences Program, Rakai, Uganda. rssekubugu@rhsp.org
authors.forename: Robert
authors.initials: R
authors.lastname: Ssekubugu
authors.forename: Elli
authors.initials: E
authors.lastname: Leontsini
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Kennedy
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Richard
authors.initials: R
authors.lastname: Sekamwa
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wagman
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects / Q000523:psychology*; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D014454:Uganda; D055815:Young Adult