Facilitators and barriers to voluntary medical male circumcision uptake among adult males in Bariadi District Council Northwest Tanzania

Abstract

Voluntary Medical Male Circumcision (VMMC) is endorsed as an effective HIV prevention strategy. Despite scale-up efforts in Tanzania, uptake remains low in traditional non-circumcising communities, highlighting the need to understand context-specific drivers influencing VMMC uptake. This study aimed to explore facilitators and barriers to VMMC uptake among adult males aged 15–49 years in Bariadi District Council, Tanzania, guided by the Social Ecological Model. A qualitative study design was employed with purposive sampling used to recruit adult men (both circumcised and uncircumcised), VMMC healthcare providers, and a community leader. Data were collected through in-depth and key informant interviews and analyzed using content analysis with the NVivo software. The findings were categorized into individual, community, and facility levels. Key facilitators included knowledge of VMMC’s health benefits, autonomy in decision-making, peer advocacy, community mobilization, positive attitudes of providers, and consistent service availability. Barriers included fear and misconceptions regarding sexual function and fertility, concerns about healing and disruption of daily responsibilities, perceived provider incompetence, time constraints, inconsistent service provision, staff shortages, and lack of age-sensitive services. This study highlights the complex interplay of individual, community, and facility-level facilitators and barriers to VMMC uptake, indicating that effective programs must address these multi-level barriers through accurate information, supportive social environments, and improved service delivery. By applying the Social Ecological Model in the underexplored, predominantly rural Bariadi District, this study fills an important gap in VMMC research, as prior literature has seldom used a comprehensive theoretical framework to examine multilevel determinants or addressed the specific cultural and contextual factors present in such settings. The findings therefore offer transferable, context-sensitive evidence to guide VMMC program design including community mobilization, peer advocacy, provider training, and age-sensitive services in similar low-uptake, non-circumcising communities across sub-Saharan Africa.