Determinants of Voluntary Medical Male Circumcision Uptake Among Adults in Luo Nyanza

Abstract

Introduction: Randomized controlled trials have demonstrated that Medical Male Circumcision offers upto 60% efficacy in the prevention of heterosexual HIV transmission. The Luo community of Kenya do not practice traditional male circumcision and have been reporting the highest HIV prevalence rates in Kenya. However, despite the concerted efforts to reach as many eligible males as possible, the response has been below expectation particularly adults. We sought to determine the extent of uptake and the factors associated with low uptake of Voluntary Medical Male Circumcision among adult men in Luo Nyanza. Methods: The study was a descriptive, cross sectional study with qualitative and quantitative components targeting men aged 18 years and above. A total 384 respondents were interviewed using structured questionaires and two Focus Group Discussions conducted. Data was organized and presented using quantitative techniques; the Chi square, Z-test and Mann Whitney U-test were used for testing for significance. Results: The study found that only 58% of adult men had undergone cicumcision while the remaing 42% had not. VMMC uptake was found to be highest among single respondents (74.8%) and least among polygamous married respondents (30.0%), p-value <0.001, it was also highest among respondents with 0 – 2 children (56.6%) and least (29.8%) among respondents with more than 5 children, p-value=0.017. The unemployed also had the highest uptake (73.3%) and least among self employed (52.2%), p-value=0.006 Conclusion: Circumcision was still unpopular among adults in Luo Nyanza and a significant proportion of adult men have not opted for circumcision. Age, marital status, number fo children, occupation and income are the key factors influencing the uptake of circumcision. There is a linear decline in circumcision uptake with increase in age. In order to accelerate the uptake of VMMC, intervention that targets the older males needs to factor in the household related factors and the roles and responsibilities of such men at different age groups.