https://www.inosr.

net/inosr-experimental-sciences/
Musinzi
INOSR Experimental Sciences 12(2):68-77, 2023.
©INOSR PUBLICATIONS
International Network Organization for Scientific Research ISSN: 2705-1692
https://doi.org/10.59298/INOSRES/2023/2.5.1000

Influences Impacting the Acceptance of Voluntary Medical Male

Circumcision among Medical Students Pursuing Bachelor’s Degrees at
Kampala International University Teaching Hospital

Musinzi Joel

Faculty of Clinical Medicine and Dentistry Kampala International University Western

Campus Uganda

ABSTRACT
The primary objective of this investigation was to identify the determinants influencing the
adoption of voluntary medical male circumcision services among bachelor’s male medical
students at Kampala International University Teaching Hospital (KIU-TH). The study
employed a cross-sectional descriptive design over a three-month period within Bushenyi
District-Uganda, specifically at KIU-TH situated in Ishaka town. This hospital, a private
institution, serves as a prominent teaching center for various medical programs. A sample
of 372 bachelor’s male medical students participated in the study, responding to simple
pretested semi-structured questionnaires. Analyzing the collected data via SPSS version 20
revealed a mean age of 28±5.504 years, ranging from 19 to 50 years. Predominantly,
participants were in their 4th year of study (47.1%), unmarried (76.1%), identified as
Christians (78.2%), and held Ugandan nationality (79.6%). Notably, 38.7% of students
reported being circumcised, with 68.1% undergoing voluntary medical male circumcision
(VMMC). However, among uncircumcised individuals, only 25.0% expressed willingness to
undergo VMMC. All participants demonstrated awareness and comprehension of VMMC,
with 96.5% acknowledging its role in HIV prevention and 77.2% recognizing potential
complications associated with VMMC. Regarding attitudes, 68.5% held positive views on
VMMC, highlighting that pain during the procedure is manageable (40.6%) and recovery is
relatively swift (72.8%). Despite this, the uptake of Voluntary Medical Male Circumcision
remained below national targets. While a majority exhibited favorable attitudes toward
VMMC, a smaller fraction displayed willingness to engage in this procedure. The findings
underscore the necessity for evidence-based health education initiatives and structured
VMMC campaigns, specifically targeting medical students, to enhance the uptake of VMMC
services.
Keywords: Male circumcision, Healthcare providers, Male medical students, HIV, Health
education.

INTRODUCTION
Circumcision is one of the oldest surgical procedures are performed in infancy or
procedures, dating from the Neolithic age. childhood, but in some cultures,
It is widely practiced throughout the circumcision is part of initiation rituals
world for religious reasons (e.g., Muslims marking the transition from adolescence
and Jews), as part of traditional cultures to adulthood (e.g., Xhosa of South Africa)
among tribal groups in Africa (e.g., Kikuyu [3]. About 665 million men (30% of all
in Kenya and Bagishu in Uganda); and for men) over 15 years of age worldwide are
medical reasons both preventive and circumcised of whom approximately two-
therapeutic [1, 2]. The majority of thirds (68%) are Muslim, 0.8% are Jewish,

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and 13% are men in the United States who 380,000 men (9.0 %) had actually been
are not Muslim or Jewish [4]. On one circumcised under the program [13]. Male
hand, there are communities that do not Circumcision is more common in urban
traditionally circumcise and those who than rural. It is more common in Kampala
see such campaigns to take up male than elsewhere in the country except for
circumcision (MC) as an affront to their the eastern and western regions where MC
culture [5]. Voluntary medical male is carried out as a rite of passage and
circumcision (VMMC) is the surgical maturity transition among the Bagisu,
removal of the foreskin of the penis by Sabiny, and Bakonzo, and 80% of men are
trained healthcare providers after the reportedly circumcised [5].
client’s consent [6]. WHO and UNAIDS Voluntary medical male circumcision is a
recommend MC as an emphasis for critical HIV prevention tool [14, 15]. After
efficacious intervention for HIV its launch in 2010 in Uganda, VMMC was
prevention in countries and regions with intended to achieve 80% male
heterosexual epidemics, high HIV, and low circumcision by the year 2015 as part of a
circumcision prevalence. This is further comprehensive HIV prevention strategy
backed up by the evidence that the inner [16]. However, slower progress has been
aspect of the foreskin is highly observed since then including a 9.0%
susceptible to only HIV infection but also reported uptake in two years after the
other Sexually Transmitted Infections [7, launch [13]. Uganda is second (after South
8]. Voluntary medical male circumcision Africa) among the African countries that
has been shown to provide a 50% – 70% require a relatively high uptake of VMMC
reduction in the risk of HIV infection [17]. Despite being faithful to one sexual
without contributing to behavioral partner, using a condom for sexual
disinhibition of safer sexual practices [9]. intercourse with a person whom one is
VMMC is done among adult males of ages not sure of their safety and abstinence
18 years to 50 years who consent to the from sex [6] can help prevent STIs,
procedure. In Africa, it has been found Voluntary Medical Male Circumcision
that male circumcision (MC) can reduce made part of HIV prevention programs in
the risk of HIV infection by 50% to 60% regions with a generalized HIV epidemic
among heterosexual men [10]. Within and a low level of male circumcision has
Mazowe District, Zimbabwe, the shown commendable results regarding
prevalence of male circumcision was HIV prevention [12]. However, among
noted to be higher than the 10% that was medical students particularly at Kampala
reported by the WHO in 2009 [11]. In International University’s western
Kenya, the level of uptake of VMMC rates campus, the level of uptake of VMMC is
at 75% as per a study done in the Kibera still incomprehensible. Thus, this study
division [12]. In Uganda, the male sought to determine the level of
circumcision program was launched in utilization of VMMC and the associated
September 2010, targeting 4,200,000 (80 factors among bachelor’s medical
percent) of uncircumcised men by 2015. students at KIU-WC.
By March 2012, however, only a total of
METHODOLOGY
Study design Kampala, the largest city in the country
The study employed a cross-sectional and its geographical coordinates are 0° 32'
descriptive study design to collect both 29.04"S, 30° 8' 25.80"E (Latitude: 0.5414;
quantitative and qualitative data. Longitude: 30.1405). The university offers
Area of Study tertiary learning from certificate to PhD
The study was conducted at KIU-WC a levels in various disciplines of higher
private international university located in learning including, health sciences,
Ishaka Town about 3km from Bushenyi humanities, biomedical sciences,
district headquarters. The university’s education, basic sciences, and computer
location lies approximately 360 sciences. It has up to about four thousand
kilometers (220 mi), by road, southwest of students with majority being the health

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science students. Among the health structured questionnaire in English
science students, a big proportion are developed to collect the data needed so as
males. It has a teaching hospital in its to fulfill the objectives. The questionnaire
vicinity where medical students in their contained both closed and open-ended
clinical years are taught practical skills. questions.
Study population Data analysis
Male bachelor’s medical students at Using IBM Statistical Package for the
Kampala International University Social Sciences (SPSS) version 20 data was
Teaching Hospital. analyzed and analyses were presented in
Inclusion criteria the form of cross-tabulation, Bi-variate
Male bachelor’s medical students at KIU- and multi-nominal logistic regression
TH who were present at the time of data correlations, and also in graphs,
collection and consented to participate frequencies, and percentages at a 95%
were included. confidence interval and 5% degree of
Exclusion criteria precision.
Male bachelor’s medical students who Quality control
declined consent and those who were To ensure quality work, the inclusion and
mentally or physically ill were excluded. exclusion criteria were strictly adhered to
Sample size determination and data forms were double-checked for
The sample size of respondents was completeness by the principal
determined using the Kish Leslie sample investigator. The reliability of the
size formula (Kish Leslie, [18] as given questionnaire was attained through pre-
below: testing. Respondents who didn’t
n=z2 p(1-p)/E2 understand the question had the option of
Where; inquiring from the researcher. Collected
n = sample size required. data was checked for consistency and
p = 59%, Proportion of males who were completeness and proper storage of the
circumcised in a study by Miiro et al. [19] questionnaires was ensured.
in Entebbe, Uganda. Ethical considerations
z = Standard normal deviation, i.e. 1.96, Approval was sought from the Research
set at 95% confidence level Ethics Committee of Kampala
d = desired degree of accuracy i.e. 5%. International University, Western Campus,
Therefore, n = 1.96 x 1.96 x 0.59 x (1- and ethical concerns were addressed.
0.59)/ 0.05 x 0.05 Restricted access to the data collection
n = 3.8416 x 0.59 x 0.41 / 0.0025 forms by persons other than the principal
n = 372 medical students were sampled. researcher was ensured. No names or any
Sampling techniques identifying information were used in the
Using simple random sampling male study. The respondents were properly
bachelor’s medical students were selected informed upon this subject and neither
from three schools i.e. School of Clinical were they forced or influenced to answer
Medicine and Dentistry, the School of any question as per the researcher’s
Allied Health Sciences, and the School of interest. Verbal consent was obtained
Nursing until the desired sample size was from the respondents who were first
achieved. informed about the importance of the
Data collection methods and study.
management
Data was collected using a pre-tested
standardized self-administered semi-
RESULTS
Uptake of Voluntary Medical Male circumcised while 228 (61.3%) were not.
Circumcision among bachelor’s medical Of those who were circumcised, 98
students (68.1%) were circumcised via VMMC, while
Out of the 372 sampled bachelor’s 46 (31.9%) were not circumcised through
medical students, 144 (38.7%) were VMMC and among those who were not

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circumcised, the majority (75.0%) were circumcise through VMMC as illustrated in
not willing to circumcise via VMMC with table 1 below.
only 57 (25.0%) who were willing to
Table 1; showing uptake and acceptance of VMMC among bachelor’s medical students
Variable Frequency, N/372 Percentage
Are you circumcised
Yes 144 38.7
No 228 61.3
If yes, where you circumcised via VMMC?
Yes 98 68.1
No 46 31.9
N/A (228) - -
If no, would you wish to circumcise via
VMMC?
Yes 57 25.0
No 172 75.0
N/A (144) - -
Source: Field data

Students socio-demographic years. The mean age was 28±5.504 and

characteristics the median age was 26 years.
From Table 2 below, the minimum age
was 19 years and the maximum was 50
Table 2; shows age of the bachelor’s medical students
VARIABLE Median Mean Std. Deviation Variance Minimum Maximum
Age 26 28.35 5.504 30.293 19 50
Source: Field Data
Regarding their socio-demographic married (79) and those who were
characteristics, the majority (47.1%) of the divorced/separated (10). Many of the
students were in their 4th year of study students were Christians (78.2%) while
followed by those in the 3rd year (24.2%), Muslims were only 20.7% and those of
those in 5th year (18.5%), and then those in other religious afflictions were 1.1%. The
the 2nd year (10.2%). Regarding their biggest of the students were Ugandans
marital status, the majority were single (79.6%) and only 20.4% were foreigners as
(283), followed by those who were shown in table 3 below.
Table 3; showing students’ socio-demographic features
VARIABLE FREQUENCY, n/372 PERCENTAGE
Year of Study
Second year 38 10.2
Third year 90 24.2
Fourth year 175 47.1
Fifth year 69 18.5
Marital Status
Single 283 76.1
Married 79 21.2
Divorced/Separated 10 2.7
Religious Affiliation
Christian 291 78.2
Muslim 77 20.7
Others 4 1.1
Nationality
Ugandan 296 79.6
Non-Ugandan 76 20.4
Source: Field Data

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Students knowledge regarding 1.9% didn’t know and were not sure
Voluntary Medical Male Circumcision respectively. Regarding their opinion
From Table 4 below, all students had ever about why VMMC is carried out, the
heard about VMMC and could explain majority (90.6%) mentioned that it is done
what it means and the majority had heard to prevent HIV and other STIs followed by
about it through media (52.2%), followed those who mentioned it due to hygiene
by those through peers (22.3%), from purposes (8.3%) and then those with other
school (12.9%), from other sources (8.6%) reasons (1.1%). The biggest proportion
and then from the community. 96.5% of (77.2%) knew that VMMC can result in
the students knew that male circumcision complications while 20.7% said and 2.2%
can help prevent HIV while only 1.6% and were not sure.
Table 4; shows students’ knowledge regarding VMMC
Variable Frequency, N/372 Percentage
Have you ever heard about VMMC?
Yes 372 100.0
No 00 0.0
Where did you hear it from?
From school 48 12.9
Through media 194 52.2
From community 15 4.0
From peers 83 22.3
Other sources 32 8.6
Can explain what VMMC means?
Yes 372 100.0
No 00 0.0
Male circumcision helps prevent HIV
Yes 359 96.5
No 6 1.6
Not sure 7 1.9
Why do you think VMMC is carried out?
HIV and other STI prevention 337 90.6
Hygiene reasons 31 8.3
Other reasons 4 1.1
VMMC can result in complications
Yes 287 77.2
No 77 20.7
Not sure 8 2.2
Source: Field Data
Student’s attitude and perception it takes long to heal after VMMC, 21.8%
towards Voluntary Medical Male agreed however 5.4% were not sure. More
Circumcision than (57.0%) agreed that male
Out of the 372 sample medical students, circumcision reduces sexual pleasure in
255 (68.5%) had a positive attitude men, with 29.0% and 14.0% disagreeing or
towards VMMC while 115 (31.5%) had a being not sure respectively. Over ninety
negative attitude. 30.4% agreed with the percent of the students disagreed with the
statement that pain during VMMC is statement that VMMC is against my
unbearable, 40.6% disagreed and 29.0% religion as illustrated in Table 5 below.
were not sure. While 72.8% disagreed that

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Table 5; shows students’ attitude and perceptions toward VMMC
VARIABLE FREQUENCY, n/372 PERCENTAGE
How do general feel about VMMC?
Good practice 255 68.5
Bad practice 115 31.5
Pain during VMMC is unbearable
Yes 113 30.4
No 151 40.6
Not sure 108 29.0
It takes long to heal after VMMC
I agree 81 21.8
I disagree 271 72.8
Not sure 20 5.4
Male Circumcision reduces sexual pleasure in men
I agree 212 57.0
I disagree 108 29.0
Not sure 52 14.0
VMMC is against my religious practice
Yes 34 9.1
No 338 90.9
Source: Field Data
DISCUSSION
Uptake of VMMC misconceptions towards VMMC even
This current study has discovered that among medical professionals which is a
38.7% of the students were circumcised of big hindrance to the overall level of
which 68.1% were circumcised via VMMC. uptake across all social and economic
However, among those who were not sects.
circumcised only 25.0% were willing to Knowledge towards VMMC
circumcise via VMMC. These findings were Findings from this study have shown that
slightly lower as compared to discoveries all students have ever heard about VMMC
in Kenya, where the level of uptake of and knew the meaning of VMMC. It has
VMMC was high at 75% as per a study also revealed that 96.5% knew that male
done among adult men in the Kibera circumcision prevents HIV transmission
division [12]. However, slightly higher as and 77.2% knew that VMMC can result in
compared to results in Entebbe Uganda complications. This was similar to a study
where the prevalence of VMMC among among healthcare providers in Haiti
adolescent boys was 59% [19] and another where the majority (90%) of the
by Mukama and colleagues where about participants said that MMC would reduce
half (50.6%) of the respondents had STIs [21] and in another study carried out
undergone VMMC at the health care in Uganda, most of the men who were
facility [20]. This improvement may be health educated about VMMC were aware
attributed to the fact that these are of the safety of VMMC during surgery
medical students who are believed to [22]. On the contrary, however, these
have awareness and easy accessibility to findings are contradictory as related to
the services. However, with such assumed earlier discoveries including one in
awareness and accessibility, the level of Botswana where the majority of the
uptake is still below target. Considering respondents were not aware that medical
willingness to uptake VMMC, this current male circumcision reduces the risk of HIV
rate (25.0%) is slightly lower as related to infection [23], in Eastern Uganda, where
an earlier study carried out in Rakia some men never realized the value in
District Central Uganda which showed medical male circumcision as far as HIV
that 27% of the studied population was infection prevention is concerned when
willing to undergo circumcision. This low they are advised to continue using
rate may be attributed to the existence of condoms after the procedure, in Namibia

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where the majority (84.6%) of the where it was concluded that circumcision
respondents did not out rightly know that decreases sexual enjoyment due to loss of
circumcision reduces the risk of HIV nerve endings [27], in South Korea where
infection [24] and in Rakai, Uganda where majority of the respondents believed that
most males never had adequate men were twice more likely to experience
knowledge about MMC and the few who diminished sexuality rather than
had knowledge was not translated into improved sexuality when they are
actual utilization of MMC available in the circumcised [28]. Another study at Mutare
area due to misconceptions that they had Rural District Zimbabwe also revealed that
about the efficacy of the equipment used majority 204 (87%) of the respondents
to perform the service [25]. This current believed that circumcision diminishes
level of knowledge regarding VMMC is sexual pleasure which would eventually
comparable to findings by Hoffman et al. lead to loss of their partners [28]. On the
[26] in South Africa which revealed that contrary however other studies revealed
majority (93.3%) of the respondents had that VMMC doesn’t adversely affect the
heard about male circumcision, and many sexual function among men [29] and
(64.4%) knew of VMMC from someone in another study in Nyanza Province Kenya,
the community who was circumcised, showed that most respondents thought
others from a family member (46.2%) that the removal of the fore skin of the
while 28.8% heard from government penis enhances sexual pleasure which
campaigns and less than one fifth through would help them to strengthen their
formal contact with the health care marriages [30]. Similar beliefs were still
system either directly or through the obtained in Uganda where most of the
media [26]. respondents never believed that male
Attitude and Perception towards VMMC circumcision diminishes sexual pleasure
This study has shown that 68.5% of the [5]. These current findings may be
students have a positive attitude towards attributed to the fact that more than half
VMMC and majorities reported that pain of the respondent has a positive attitude
during VMMC is bearable (40.6%), that and had circumcised via VMMC, an
VMMC reduces sexual pleasure among indication of acceptance and uptake. Thus
men (57.0%) and that it does not take long responding to the questions was from
to heal after VMMC (72.8%). Similar personal experience and not from peer or
discoveries have been found in China other misconceptions.
CONCLUSION
Uptake of Voluntary Medical Male i. Evidence based health education
Circumcision is still below national target; should be offered even among the
and much as more than half of the medical workers including health
students had a positive attitude towards care students as a way to increase
voluntary medical male circumcision, a acceptance and eventual uptake of
small proportion of them were willing to voluntary male medical
circumcise through voluntary medical circumcision.
male circumcision. ii. The hospital and campus
Recommendations management through it co-
Basing on the study findings above, the curricular activities should
following are recommended to help schedule yearly or quarterly
improve level of acceptance and uptake of campaigns for voluntary medical
voluntary medical male circumcision male circumcision involving even
across all social groups: the students.
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CITE AS Musinzi Joel 2023 Influences Impacting the Acceptance of Voluntary Medical
Male Circumcision among Medical Students Pursuing Bachelor’s Degrees at Kampala
International University Teaching Hospital. INOSR Experimental Sciences 12(2):68-77.
https://doi.org/10.59298/INOSRES/2023/2.5.1000

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