OBJECTIVES: Medical Male Circumcision (MMC) is a potentially cost-effective strategy for prevention of HIV transmission. Several high-HIV-burden countries in sub-Saharan Africa will fall short of WHO targets for MMC. To inform demand creation policy, we examined heterogeneity in preferences for the attributes of MMC services, and the impact of subjective beliefs about HIV and MMC in determining preferences.

METHODS: We conducted a discrete choice experiment among 406 self-reported uncircumcised, HIV-negative men between 18-45 years-old in a high-HIV prevalence community in Uganda. We used mixed- and latent-class-logit models to examine heterogeneity in preferences for: accessing services at permanent versus temporary health facilities, distance travelled to access services (1km, 5km, 15km), number of week-days during which circumcision services were available (1, 3 and 5 days), privacy (complete, some, none), device versus surgical circumcision, incentives for getting circumcised (none, voucher and cash), and price/value of incentive (continuous: positive values indicating price and negative values indicating incentive value).

RESULTS: Marginal utilities (µ; se) were highest for accessing services at permanent facilities (2.138; 0.214), and incentives: voucher vs none (0.512; 0.153) and cash vs none (0.968; 0.174). Marginal disutility (µ; se) was highest for device circumcision (-1.674; 0.265). We identified three groups of individuals with distinct preference patterns. There was significant heterogeneity in preferences for accessing services at permanent facilities (partly explained by subjective probability of pain during circumcision), number of week-days during which services were available, device circumcision (partly explained by difference in the subjective probability of infection and pain from the circumcision procedure, expected time away from work and sex after circumcision), cash incentives and price/value of incentive compensation.

CONCLUSIONS: MMC uptake could be optimized by designing services that cater to group preferences for permanent health facilities, surgical circumcision and incentives. Demand creation policies should also address perceptions about the outcomes of MMC.