Circumcisions performed so far in the USAID-funded HIV prevention program in Njombe, Iringa and Tabora should avert 16,000 future HIV infections.

Christopher Miho (right), with his son, Iddi (left), was the 100,000th client to receive the free voluntary medical male circumcision services provided by the USAID-funded MCHIP program in Iringa, Tanzania

Mafinga, Tanzania—A government-supported public health campaign launched in late 2009 to prevent the transmission of HIV in Iringa, Njombe and Tabora regions has reached a milestone this week, providing medical circumcision services to its 100,000th client. Mathematical modeling estimates that 16,000 future HIV infections will be averted between now and 2025 as a result of these 100,000 circumcisions.

The free voluntary medical male circumcision (VMMC) for HIV prevention program has served 90,000 clients in Iringa and Njombe and 10,000 clients in Tabora. Specially trained health providers from the Ministry of Health and Social Welfare (MoHSW) provide a complement of services – including HIV counseling and testing – with circumcision.

The campaign  is funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) and is implemented by the Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego, an affiliate of Johns Hopkins University.

"This is a big achievement in the fight against HIV and AIDS in our region," said Getrude Mpaka, Iringa Regional Administration Secretary.

"I am so thrilled with the performance by the Iringa team. It's through partnerships, it's about working together, and I commend the administration in Iringa for its commitment in addressing HIV in the region," said Dr. Leslie Mancuso, Jhpiego President and Chief Executive Officer, who is visiting the Iringa region.

Dr. Mancuso had the opportunity to meet and congratulate the 100,000th VMMC client, Christopher Miho, 36, a logging truck driver who arrived at the Nyololo Health Center in Iringa. With his procedure, the campaign hit an important mark in the ongoing effort to reach more than 210,000 adolescent and adult males aged 10 to 49 in Iringa and Njombe regions, and nearly 220,000 in Tabora region by 2015.

"I wanted to do this last year but because of the logging season at the Sao Hill forest reserve, I couldn't," said Miho, who lives in Nyololo village. "We have just started a two-month break, waiting for new logging permits and licenses to be released and I didn't want to lose this opportunity again".

Miho is married to Elina Nyankinga and they have three children, two sons and a daughter. When Miho told his wife that he wanted to go for VMMC, she was highly supportive. Having lost members of his community because of HIV, Miho didn't need many lessons on the benefits of VMMC.

"I like this service, it is good. Circumcision lowers the risk of contracting diseases such as HIV and sexually transmitted infections. Plus, my wife will benefit too as VMMC lowers risk of getting cancer [penile as well as cervical cancer in women]," he said.

The couple's eldest son, Iddi, 17, accompanied his father to the health center; he too was circumcised.

Commenting on the milestone, Dr. Robert Mahimbo, the Regional Medical Officer, said, "We are grateful to Jhpiego and the American people for their support. We hope the people from this great nation will continue supporting efforts to bring down HIV transmission in our region."

The milestone 100,000 circumcisions will avert approximately 16,000 new HIV infections between now and 2025, saving hundreds of millions of US dollars in future costs for HIV treatments. For every US dollar spent by the program in Iringa and Njombe, 14 US dollars are saved in future treatment costs.

Research has shown that when scaled up rapidly in areas with high HIV prevalence, male circumcision is an effective HIV-prevention strategy, reducing heterosexual men's risk of acquiring HIV by approximately 60 percent, and also reducing a woman's risk of coming into contact with a HIV positive man.

Used in combination with other HIV prevention measures, including condoms, partner reduction and abstinence, circumcision is an important addition to men's HIV-prevention options. In addition to lowering the risk of becoming infected with HIV, male circumcision improves hygiene, reduces the risk of contracting sexually transmitted infections (STIs), and lowers the risk of penile cancer in men and cervical cancer among female partners.

At almost 16 percent, Iringa and Njombe have the highest prevalence of HIV in Tanzania—three times the national average, with only one-third of men being circumcised. Unlike in other parts of the country, such as the pastoralist communities and coastal areas—where rates of male circumcision are high and HIV prevalence is low, male circumcision is not a tradition for males in these regions.

In just two and a half years of intensive scale up in areas where neither the procedure nor its benefits were known, VMMC is gradually becoming the new normal in the three regions. Most notable is the participation of women in the campaign, which is breaking ground and stereotypes.

From encouraging and accompanying their partners to access health services and seeking more information on post-operative challenges, women are playing critical roles in the success of this initiative. Seventy percent of the more than 200 health providers working on VMMC are nurses. They are the frontline health workers providing education about male circumcision, counseling and HIV testing services, screening for STIs, risk reduction counseling, guidance on condom use, and above all, performing VMMC surgical procedures proficiently and safely.

Registered Nurse Selina Mtweve, 38, was the VMMC provider who performed surgery on Miho. "I am very excited to have been the provider to attend the 100,000th client," she said. "All the clients we have served are now our champions out there, on HIV prevention, and in spreading the message on VMMC."

Selina Mtweve, Registered Nurse, was the VMMC provider who attended the milestone 100,000th client in Nyololo, Iringa.

Male circumcision is also increasing men's access to healthcare in Iringa and Njombe providing an opportunity to a group that has traditionally been reluctant to approach health facilities. Besides the VMMC messages and services, men and their partners are given a package that includes education and counseling about HIV and other reproductive health issues, HIV testing, STI screening and condom promotion.

Clients who test HIV-positive and were not previously aware of their status or in care are referred to care and treatment services, often offered in the same facility. Before surgery, clients also receive a health check, which provides further opportunity for referral for men identified with other health problems such as hypertension.

The next phase of the VMMC program will see an acceleration in the scale-up of VMMC services in these regions and the introduction of early infant male circumcision— the key to the long-term success of VMMC and sustainable HIV prevention.

For more details on the MCHIP VMMC Program and Jhpiego activities in Tanzania please contact Dr Charles Wanga, Jhpiego Publications and Communication Officer, cwanga@jhpiego.net; Mobile: +255 784 337232.