Male circumcision uptake in Uganda and it's associated factors: a structural equation modelling approach

Abstract

The World Health Organization (WHO) and UNAIDS recommend male circumcision as a preventive measure against HIV, with evidence showing about a 60% reduction in the risk of male-to-female HIV transmission. This study aimed to identify factors influencing the uptake of male circumcision in Uganda. Data from 5,008 men aged 15–54 years were drawn from the Uganda Demographic and Health Survey. A Generalized Structural Equation Model (GSEM) was applied to simultaneously estimate both direct and indirect effects of potential predictors on circumcision uptake. Results from direct effect analysis show that, holding other factors constant, increased likelihood of having undergone male circumcision was associated with men with secondary education (coef = 0.153, p=0.000) compared to men with no education, men who are rich (coef= 0.076, p =0.000) compared to men who are poor, men living with a partner (coef= 0.087, p =0.000) compared to men never in union. However an increase in the age of respondents was associated with less likelihood of having undergone male circumcision. Indeed the likelihood of having undergone male circumcision was lower for age group 35-44(coef= -0.139, p=0.000) and age group 45-54(coef= -0.176, p= 0.000) compared to age group 15-24. ). Also rural residents were less likely to have undergone male circumcision (coef= -0.069, p =0.000) compared to urban residents. Region was also found to significantly affect male circumcision status. Indeed, men from northern (coef = -0.237, p = 0.000) and western (coef=-0.108, p=0.000) were less likely to have undergone male circumcision compared to men from Central. Indirect effect analysis showed no significant mediation through comprehensive HIV knowledge, indicating that observed associations were driven entirely by direct effects. Increasing male circumcision uptake in Uganda requires targeted health education for men with lower education levels, expanded free or subsidized services for poorer men, and couple‑focused communication to encourage partner support. Age‑specific interventions should address older men’s concerns about pain and healing, while rural access must be improved through mobile clinics, community health workers, and local leadership engagement. Finally, region‑specific strategies that respond to cultural beliefs and service gaps are essential to ensure equitable uptake across the country.