At an ICAP-supported clinic in Siaya County, Kenya, Mr. Morris Walugwe arrives to receive voluntary medical male circumcision. Mr. Walugwe is one of the thousands of men electing the procedure as part of a broader national health strategy in countries most affected by HIV.
[Photo: In Tanzania, young boys attend an ICAP-supported mobile clinic for medical circumcision]
Several studies have shown definitively that male circumcision can reduce by 60 percent the risk of men getting HIV infection from their HIV-infected female sex partners. Male circumcision has also been shown to decrease transmission of other sexually-transmitted infections. In view of these findings, WHO and UNAIDS recommended implementing voluntary medical male circumcision in countries with high HIV prevalence and low rates of male circumcision, identifying 14 priority countries for scale-up of the procedure.
ICAP at Columbia’s Mailman School launched male circumcision projects in three of those countries: Kenya, Mozambique, and Tanzania. In all three, ICAP’s support has been enormously successful, and the eagerness of individuals to take advantage of new HIV prevention approaches has been equally promising. In addition to skilled clinical providers, equipment and facilities, many of the accomplishments can be attributed to successful engagement of communities. Men from all walks of life came to speak openly about the advantages of the surgery and have advocated within their own communities.
In Kenya, ICAP has partnered with the Ministry of Health since 2009 to support HIV prevention, care and treatment in Nyanza Province. ICAP began supporting male circumcision in 2012 in six health facilities and, over the next two years, expanded to 24 health facilities, working with the local health officials to offer free voluntary medical male circumcision services and providing community outreach to increase awareness and mobilize men.
To enable the scale-up of services in these regions, where medical circumcision is not common practice, ICAP has worked to strengthen the health system and build capacity. Using a national training protocol, clinical staff was trained on the procedure, and counselors provided HIV testing as an integral part of the process. In addition, central to engaging individuals were community health workers and mobilizers who conducted outreach about the benefits of circumcision and the risks of HIV infection. As a result of these efforts, over 26,000 men over the age of 15 have received medical circumcision through ICAP-supported programs and over 60 percent of all circumcised patients have received post-operative follow-up care.
Building on the lessons learned in Kenya, ICAP began supporting male circumcision for HIV prevention in Tanzania, utilizing four approaches to support these activities: service delivery, continuity of care, demand creation, and coverage expansion. To date, almost 56,000 men in Tanzania have been circumcised through ICAP-supported programs and 86 percent have also received HIV testing and counseling.
In Mozambique, ICAP is working closely with provincial and district health networks to plan, implement, and support HIV programs by addressing infrastructure, human resources and training, quality assurance and monitoring and evaluation needs.