The southwestern region of Uganda still exists among the high HIV risk regions in the country (UPHIA, 2017). Recent statistics show the regional HIV prevalence is estimated at 7.9%, the second highest in the country, following central region, which is at 8% (UPHIA, 2017). Since inception, Integrated Community Based Initiatives (ICOBI), anon‐governmental community-based organization based in Sheema district, Kabwohe Town Council, has fostered a mission to improve the quality of life of people through holistic and sustainable programs that meet the basic human needs of families under four key themes:(i) advocacy for better health, (ii) health service provision,(iii) health systems strengthening,(iv) operations research as well as policy and guideline formulation. As such, ICOBI has built a strong record in provision and support for STD/HIV/AIDS and reproductive health (adolescent health, MCH/family planning) among others. ICOBI has also been actively advocating for an HIV-free generation through community PMTCT programs in southwestern Uganda.

ICOBI has undertaken various projects. One example is the “Linkages MMC Study” whose major objective is to explore factors that facilitate or are potential barriers to engagement in MMC interventions for HIV prevention. This study set out to:

Aim 1: Understand thebarriers to uptake of MMC services
Aim 2: Understand MMC demand creation strategies to improve uptake
Aim 3: Explore the various linkage strategies to MMC services

The study involved 46 in-depth qualitative interviews with purposefully sampled men who tested HIV negative from the villages of Itendero, Nyanga, Mabare, Runyinya, Rushozi, Kitojo, Kiziba and Kyagaju in Sheema district, Ankole Sub region.

Overall, the study findings revealed willingness and interest in MMC services mainly to prevent HIV and other sexually transmitted diseases, and improvement of general hygiene.

When the counselor came, he taught me about circumcision, that if I have a wife, she can’t get cervical cancer, secondly, I will become clean and he also told me that if I have sex with an HIV infected person without a condom, I have a 50% chance of not getting infected.

However, a number of factors were found to be deterring these men from accessing MMC services, for example:

Pain and associated fears such as complications, length of the healing process and pain associated with the procedure

Financial and other constraints such as travel expenses to the health facility, medication and time spent off work. These are peasant farmers living on “hand to mouth” therefore taking a month off work in order to heal would affect their families ‘survival.

You see people like us who do manual work, we feel hesitant to go to circumcise because we fear that the wound might not go easily.

Accessibility: For some, in spite of their willingness to get circumcised, circumcision services were not available. This was especially reported by participants from Muzira and Runyinya parishes which are quite remote, approximately 15km from Kabwohe H/C IV.

Misconceptions about the practice/religious beliefs also emerged.

I have grown up knowing that circumcision is for Muslims; I knew that when you circumcise, then you have become a Muslim. But the counselor told me when you circumcise, it doesn’t mean that you have become a Muslim. Then he told me that some people circumcise to reduce chances of acquiring HIV. I got to know that and started thinking when I get a chance, I will go and cut.

To understand the demand creation and linkage strategies to improve uptake, the study findings revealed that many participants showed interest in circumcision after discovering their HIV negative status. This should lead to a call to the government to intensify routine HIV counseling and testing among the population. Many participants further advocated for circumcision services to be brought close to their villages so that transport expenses are not incurred.

The Linkages MMC study was built on the theoretical frameworks of the health belief model to explain and predict lay people’s health seeking behavior upon knowing their HIV status. Drawing on this model, it was anticipated that understanding the susceptibility and severity of the HIV scourge would eventually compel community members to seek MMC services especially after they have tested HIV negative. However, failure to address the subjective norms resulting from the social and environmental surrounding normally yields perceived less control, hence less self-efficacy or confidence in the ability to successfully change individual behavior. This explains why, despite the increased willingness to undergo circumcision, issues to do with survival, accessibility and fear came out strongly as major setbacks. Overall, the study findings demonstrate that uptake of MMC by adult men is a gradual process that needs to be supported by consistent counseling messages, provision of appropriate care and generally, a comprehensive approach that cuts across social, economic and cultural aspects of the respective communities for a much wider impact in the promotion of MMC.

• http://www.icobi.org/category/publications

• Auvert, B.,Taljaard, D.,Lagarde, E.,Sobngwi-Tambekou, J.,Sitta, R.,&Puren, A. (2005). Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial.Public Library of Science, 2(11), e298.

• MOH. (2017).Annual health sector performance report 2016/2017. Kampala, Uganda.

• UPHIA. (2017).Uganda Population based HIV Impact Assessment. Kampala, Uganda.