Safe Male Circumcision for HIV Prevention among Adolescents with Deafness in Uganda: Awareness, Prevalence and Implications for Policy and Programming

Background: Safe Male Circumcision (SMC)[1] has been widely recommended by WHO as part of a comprehensive HIV prevention strategy. However, literature pertaining to SMC amongst adolescents with a disability, and the deaf community in particular, is almost non-existent. This study sought to establish SMC prevalence, knowledge, attitude and post circumcision behaviour among adolescents with deafness in Uganda. Methods: The study was cross-sectional, used a mixed-methods approach and recruited 447 participants. 363 questionnaires were administered to adolescents of age 15 - 24 years (192 males and 171 females) from three study sites. We assessed socio-demographic variables, circumcision status, post circumcision behaviour, attitude and knowledge levels towards SMC. Qualitative data was also collected from 84 participants (m=46, f=38) using focus group discussions and key informant interviews. Quantitative data were analysed using Stata software while qualitative was thematically analysed. Results: A total of 60.9% male adolescents with deafness self-reported to be circumcised. Both male and female participants reported SMC information to be highly inaccessible (84%). Only 27.8% study participants knew about the partial protective effect of SMC against HIV, 51.8% were uncertain, while 26% thought that SMC provided full protection. Both male and female respondents had a positive attitude towards SMC (68.3%) and females were more knowledgeable (50.3%) about the partial preventive effect of SMC against HIV transmission and timeframe for the resumption of sexual activity compared to males (30.2%). Linkages were noted between SMC, social networks and key sociodemographic characteristics like ethnicity, religion and education level. Conclusion: Despite a 60.9% prevalence and general positive attitude towards SMC, study findings showed limited service access and substantial knowledge gaps in SMC efficacy, also related to high-risk behaviour after circumcision. This can largely be explained by limited targeting by HIV prevention programmes among this (deaf) category of adolescents, related barriers associated with vulnerability arising from their disability (deafness) and developmental stage (adolescence). Key actors in HIV prevention efforts should demonstrate cognizance of heightened risk among vulnerable adolescent categories through more inclusive interventions to address prevailing knowledge and service gaps. [1] This study was conducted between 2015-2016 when the commonly used term was Safe Male Circumcision (SMC) and not Voluntary Medical Male Circumcision (VMMC) as its popularly being packaged now. This manuscript has stuck to the originally used SMC acronym.