title: Multilevel influences on acceptance of medical male circumcision in Rakai District, Uganda.
abstract: Despite access to safe medical male circumcision (MMC) and proven effectiveness of the procedure in reducing acquisition of HIV and other sexually transmitted infections, uptake remains suboptimal in many settings in sub-Saharan Africa, including Rakai District, Uganda. This study explored multilevel barriers and facilitators to MMC in focus group discussions (FGDs) (n = 35 groups) in Rakai. Focus groups were conducted from May through July 2012 with adolescent and adult males, with a range of HIV risk and reproductive health service use profiles, and with adolescent and adult females. Data were analyzed using Atlas.ti and an inductive approach. Participants' discussions produced several key themes representing multilevel influences that may facilitate or create barriers to uptake of MMC. These include availability of MMC services, economic costs, masculine ideals, religion, and social influence. Understanding how males and females view MMC is a crucial step towards increasing uptake of the procedure and reducing disease transmission.
authors.affiliation: a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Lilleston
authors.affiliation: b Department of Population, Family, and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Arik V
authors.initials: AV
authors.lastname: Marcell
authors.affiliation: c Rakai Health Sciences Program , Entebbe , Uganda.
authors.forename: Neema
authors.initials: N
authors.lastname: Nakyanjo
authors.affiliation: a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Leonard
authors.affiliation: d Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D036301:Qualitative Research; D012067:Religion; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014454:Uganda; D055815:Young Adult
keywords: HIV; Medical male circumcision; Uganda; sexually transmitted infections