title: Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda.
abstract: BACKGROUND
  In 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.
  
  
  METHODS
  We conducted 8 focus group discussions, stratified by sex and age, with 67 purposefully sampled participants in 4 communities in Kalangala District, Uganda.
  
  
  RESULTS
  There 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.
  
  
  CONCLUSIONS
  Previous 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.
authors.affiliation: Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, Washington, United States of America.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Nevin
authors.affiliation: Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, Washington, United States of America.|Health Alliance International, Seattle, Washington, United States of America.|Department of Anthropology, University of Washington, Seattle, Washington, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Pfeiffer
authors.affiliation: Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Simon P S
authors.initials: SP
authors.lastname: Kibira
authors.affiliation: Global Medicines Program, Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, Washington, United States of America.|Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy, Seattle, Washington, United States of America.
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Lubinga
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Aggrey
authors.initials: A
authors.lastname: Mukose
authors.affiliation: Global Medicines Program, Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, Washington, United States of America.|Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy, Seattle, Washington, United States of America.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000523:psychology; D003469:Culture; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult