Voluntary medical male circumcision uptake and perceptions among men aged 30–49 years in Ntungamo district, Uganda

Abstract

Background Voluntary medical male circumcision (VMMC) is a proven HIV prevention strategy, yet uptake among older men remains suboptimal in many settings. Understanding the level of uptake and perceptions among men aged 30–49 years is essential for improving targeted VMMC programs in Uganda. This study investigated the uptake and perceptions of VMMC among men aged 30–49 years in Ntungamo district, southwestern Uganda. Methods We conducted a cross-sectional study using quantitative and qualitative methods. Quantitatively, we randomly reviewed selected medical records (Safe Male Circumcision client form - HMIS ACP 029) of all men (10–49 years) who had undergone VMMC in the district between October 2021 and September 2023. Data entered in Microsoft Excel and descriptive analysis was performed. We also conducted 8 focus group discussions, each consisting of 8–12 men aged 30–49 years, which were audio-recorded, transcribed verbatim, and analyzed manually using thematic analysis. Results Out of 368 records of all men (10–49 years) who had undergone VMMC, only 16.1% (59/368) were aged 30–49, of which, the majority, 71.2% (42/59), were married. Qualitatively, two main themes emerged: (1) awareness of VMMC and its benefits, which included men’s understanding of VMMC and the sources of information through which knowledge was acquired; (2) perceptions of the VMMC services, encompassing perceived barriers such as fear of pain, economic and time constraints, and socio-cultural beliefs, as well as perceived facilitators of VMMC uptake, including peer influence, spousal support, and perceived health and sexual benefits. Conclusion The uptake of VMMC among men aged 30–49 years is suboptimal. While awareness of VMMC and its benefits exists, decisions to undergo circumcision are strongly shaped by perceptions of the procedure and post-circumcision care. There is a need for targeted, age-appropriate VMMC strategies that address specific barriers faced by older men while leveraging social support systems to improve uptake in this population