Safe Male Circumcision (SMC) is the surgical removal of the penile foreskin or tissue, which covers the head of the penis performed by a trained health professional such as a doctor or nurse under safe condition . SMC was recommended as a Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) prevention procedure by World Health Organisation (WHO) and The Joint United Nations Programme on HIV/AIDS in 2007 . This followed research findings of a study in Kenya, Uganda and South Africa in 2004 that indicated that circumcised heterosexual men were approximately 60% less likely to sexually acquire HIV compared to uncircumcised heterosexual men . The second Random Controlled Trials (RCT) in Uganda’s Rakai District studied four thousand nine hundred and ninety-six men aged between 15 and 49. Here, circumcision managed to reduce risk of infection by approximately 51 percent . Reasons for low-risk infections is attributed to the fact that HIV target cells in the prepuce, which tremendously reduced as a result of circumcision. The prepuce may suffer mild trauma during intercourse prompting infection. At the same time, the prepuce harbors organisms that such as Escherichia coli, and Enterococcus avium and provides a conducive environment for prolonged viral survival .
Globally, Male Circumcision (MC) was historically associated with religious and cultural practices. However, SMC has been increasingly adopted in many parts of the world. It is estimated that 38% of the world’s males aged 15 years or older are circumcised of which about 62% are Muslims residing mainly in Asia, the Middle East and North Africa, 0.8% are Jewish and 13% are non-Muslim and non-Jewish men living in the USA .
In Africa, especially in Northern and Western regions, MC is almost universal. However, its’ uptake in other parts varies considerably with low uptake reported in the African countries of Botswana, Namibia, Swaziland, Zambia and Zimbabwe . According to WHO’s report in 2018 , the prevalence of SMC is reported to be 21% in Malawi, 35% in South Africa, 48% in Lesotho, 20% in Mozambique and more than 80% in Angola and Madagascar. In East and Central Africa, the prevalence varies from almost 15% in Burundi and Rwanda to 70% in Tanzania and 93% in Ethiopia. In Uganda, SMC prevalence among men aged between 15 to 49 years was 27% in 2018, but with high levels of willingness to be circumcised among uncircumcised men. Those who expressed willingness at the time also seemed to be the ones with the largest need for protective measures .
A qualitative study in Iringa, Tanzania found that women had strong preferences for circumcised men because of the perception of low risk of infection of HIV from circumcised men, social norms favouring circumcised men, and perceived increased sexual desirability of circumcised men. The health benefits of male circumcision were generally overstated. Several respondents falsely believed that women were directly protected against HIV infection and that the risk of all STIs was profoundly reduced or eliminated in circumcised men .
A population-based survey was conducted among purposively selected respondents aged 15–49 to explore barriers and motivating factors to SMC for HIV prevention, and to assess utilization of existing SMC communication channels in Zimbabwe. The survey reported that 68% and 53% of female and male respondents respectively had heard about SMC for HIV prevention. (Hatzold, et al., 2014). Public programs for SMC are available, but they are limited, which make the uptake sometimes little despite the level of awareness. Also, perceived severity such as bleeding and infection, irritation of the glans, injury to the penis and increased Meatitis made uptake of safe male circumcision services low .
Uganda’s scenario of uptake of safe male circumcision is not far different from other countries in the region, up take is still low despite being free . The country’s target by 2015 was to circumcise 4.2 million adults, however, required an effective model to achieve . A study done in Northern Uganda in 2018, indicated that, 42% of their study participants owned a misconception that Voluntary Male Medical Circumcision (VMMC) had an impact on their sexual performance. Similarly, 35% of the same study participants believed that VMMC. contributes to promiscuity .
Given the above-ground, the authors purposed to carry out a study on the perceived risk and severity of the uptake of safe male circumcision services among young men aged 15–24 years in Rhino Camp Refugees settlement, Arua district in Uganda. Rhino Camp Refugee Settlement is a Refugee Camp in Arua District in north-western Uganda and has seven zones, which includes Ofua, Omugo, Ocea, Odobu, Siripi, Tika and Eden. The settlement has about 56,865people of which 6,824 are young male aged 15–24 years . The health services provided in Rhino Camp Refugee Settlement are VCT services, family planning, protection which encompasses prevention of sexual exploitation and abuse; maternal and child health services. The village health teams and home health promoters are the gateway to dissemination of key information on health services.
Therefore, the study answered the following questions; what perceived risks are associated with the uptake of safe male circumcision among young refugee men aged 15–24 years in Rhino Camp Refugees’ Settlement? And, how do these young men aged 15–24 years perceive the severity of uptake of SMC services? The study was carried out from January 2020 to November 2020. It intended to provide scientific evidence that would aid in scaling up safe male circumcision campaign based through advocating for the involvement of community leaders during community sensitization meetings in the various communities on the health benefits of safe male circumcision.