title: Perceived medical benefit, peer/partner influence and safety and cost to access the service: client motivators for voluntary seeking of medical male circumcision in Iganga district eastern Uganda, a qualitative study.
abstract: BACKGROUND
  Although voluntary medical male circumcision (VMMC) in Iganga district was launched in 2010 as part of the Uganda national strategy to prevent new HIV infections with a target of having 129,896 eligible males circumcised by 2012, only 35,000 (27%) of the anticipated target had been circumcised by mid 2012. There was paucity of information on why uptake of VMMC was low in this setting where HIV awareness is presumably high. This study sought to understand motivators for uptake of VMMC from the perspective of the clients themselves in order to advocate for feasible approaches to expanding uptake of VMMC in Iganga district and similar settings.
  
  
  METHODS
  In Iganga district, we conducted seven key informant interviews with staff who work in the VMMC clinics and twenty in-depth interviews with clients who had accepted and undergone VMMC. Ten focus-group discussions including a total of 112 participants were also conducted with clients who had undergone VMMC.
  
  
  RESULTS
  Motivators for uptake of VMMC in the perspective of the circumcised clients and the health care staff included: perceived medical benefit to those circumcised such as protection against acquiring HIV and other sexually transmitted diseases, peer/partner influence, sexual satisfaction and safety and cost to access the service.
  
  
  CONCLUSIONS
  Since perceived medical benefit was a motivator for seeking VMMC, it can be used to strengthen campaigns for increasing uptake of VMMC. Peer influence could also be used in advocacy campaigns for VMMC expansion, especially using peers who have already undergone VMMC. There is need to ensure that safety and cost to access the service is affordable especially to rural poor as it was mentioned as a motivator for seeking VMMC.
authors.affiliation: District Health Office, Iganga District Administration, PO Box 358, Iganga, Uganda ; Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinsika Institutet, Stockholm, Sweden ; Department of Epidemiology and Biostatistics, Makerere University School of Public Health, PO Box 7072, Kampala, Uganda ; School of Graduate Studies and Research Busoga University, PO BOX 154, Iganga Uganda.
authors.forename: Lubega
authors.initials: L
authors.lastname: Muhamadi
authors.forename: Musenze
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
mesh_terms: D001294:Attitude to Health; D002944:Circumcision, Male / Q000009:adverse effects / Q000191:economics* / Q000523:psychology* / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D057226:Information Seeking Behavior; D008297:Male; D009042:Motivation; D010465:Perception; D018570:Risk Assessment; D012747:Sexual Partners / Q000523:psychology; D014454:Uganda
keywords: Motivators; safe male circumcision