Factors associated with low uptake of safe male circumcision (SMC) and the intention not to undergo circumcision among men in Botswana

Abstract

Abstract Aim This paper investigates factors associated with low uptake of safe male circumcision (SMC) and the intention not to circumcise among men aged 15–64 years in Botswana. Subject and methods Data were collected during the 2013 Botswana AIDS Impact Survey (BAIS IV). For analysis, a sample of 3154 men was used to assess the association between being uncircumcised/not intending to undergo circumcision and different factors using descriptive statistics and logistic regression analysis. Data analysis was conducted using SPSS version 27. Logistic regression analysis results are presented as odds ratios together with their confidence intervals. All comparisons were statistically significant at p < 0.05. Results Results show that 25.1% of men reported that they were circumcised, while 50.5% did not intend to undergo circumcision. Multivariate analysis showed that several factors were significantly associated with being uncircumcised including age of 15–24 years (OR = 2.75, CI 1.82–4.19), residing in rural areas (OR = 1.31, CI 1.09–4.1.58), and having primary or less education (OR = 2.48, CI 1.87–3.30). Similarly, factors significantly associated with not intending to be circumcised included age of 34–44 years (OR = 1.60, CI 1.15–2.23), residing in urban areas (OR = 1.27, CI 1.02–1.58), and being married (OR = 1.61, CI 1.20–2.16). It was also observed that men who had not seen or heard of SMC in the past 4 weeks were 1.2 times more likely (OR = 1.27, CI 1.03–1.56) to report the intention not to undergo circumcision. On the other hand, men who indicated that they would not circumcise their male children under 18 years of age were 8.7 times more likely (OR = 8.70, CI 6.35–11.94) to report that they did not intend to circumcise. Conclusion Results from the study show high acceptability but low uptake of SMC. Some individual behavioral factors influencing circumcision status and decision whether to undergo circumcision were identified. Targeted interventions, continuous education, and expansion of the SMC programme are recommended, especially for older men and those in rural areas.