Thesis:

Determinants of voluntary medical male circumcision uptake in Turkana county, Kenya

Voluntary Medical Male Circumcision (VMMC) is proven to reduce heterosexual HIV transmission by up to 60% and lower risks of other sexually transmitted infections and cervical cancer. However, coverage in Turkana County remains at 12.7%, far below the national average of 84%, contributing to a local HIV prevalence of 6.8%. Understanding determinants of VMMC uptake among men aged 20–49 years is therefore crucial. A cross-sectional study involving 387 households, selected through stratified random sampling, employed a pre-tested structured questionnaire and thematic analysis of nineteen key-informant interviews. Quantitative data were analyzed using STATA v15; descriptive statistics and odds ratios (OR) at a 95% confidence interval assessed associations. Among 370 participants (95.6% response rate), 64.7% were aged 20–29 years, and overall VMMC uptake reached 67.5%. Cultural acceptance (p=0.076), concerns over stigma (p=0.065), and perceived negative attitudes of healthcare workers (p=0.127) did not achieve statistical significance. Awareness of service availability demonstrated a strong association with uptake (cOR=57.2, 95% CI: 20.1–162.9, p<0.001; aOR=5.98, 95% CI: 1.36–26.3, p=0.018). Additional positive predictors included knowledge of recommended circumcision ages, hygiene benefits, proximity to equipped facilities, and availability of services at Sub County level. The moderate uptake reflects critical gaps in awareness and accessibility. The County Health Management Team, community health volunteers, and local cultural and religious leaders should intensify community sensitization and mobilization efforts, emphasizing information on service availability, target age groups, hygiene advantages, and precise facility locations. Sensitization efforts should include community dialogues, outreach campaigns at local markets and religious gatherings, and distribution of informational materials in the Turkana language. Such targeted outreach is expected to drive uptake towards national targets and reduce HIV transmission in Turkana County.