Iringa, Tanzania—A public health campaign to prevent the transmission of HIV in the Iringa region reached a milestone this week: a government-supported, USAID-funded program provided free male circumcision services to more than 25,000 clients.
Iringa has the highest prevalence of HIV in Tanzania. Unlike other parts of the country, male circumcision is not a routine health practice here with only one-third of men being circumcised. Research has shown that circumcision is an effective HIV-prevention strategy, reducing heterosexual men’s risk of acquiring HIV by 60%. When 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. Since MC-for-HIV-prevention activities began in Iringa in October 2009, more than 25,000 circumcisions have been performed, helping to avert nearly 6,000 new infections, according to program managers.
The project has been carried out in collaboration with the Tanzania Ministry of Health and Social Welfare and with funding from the U.S. President’s Emergency Plan for AIDS Relief through the U.S. Agency for International Development’s global, flagship Maternal and Child Health Integrated Program (MCHIP), which is implemented by Jhpiego in Tanzania.
“The Iringa male circumcision program is of the highest caliber and has moved Tanzania’s HIV prevention efforts forward in ways not previously seen,” said Laura Skolnik, the HIV Prevention Team Leader at USAID, who has observed the program since its inception two years ago. “Jhpiego has been contributing to the Tanzanian government’s goals to champion the scale-up of MC as one of our most effective HIV-prevention interventions. Through the MC program, lives are being saved in the community where it counts.”
Kesali, a clothing salesman, was the program’s 25,000th client, taking advantage of the free MC services. Although he had considered circumcision in the past, Kesali, like many other clients, didn’t know where he could access free services.
Born and raised in Makambako, a town in Iringa, Kesali, 30, said neither his father nor close male relatives are circumcised. As younger man, during summer outings and swimming, he said he was teased and ridiculed when others noticed he was uncircumcised. Most recently, he said, his travels for business caused him embarrassment when he had to urinate in public. And there was one incident with a former girlfriend that, he says, was especially “demoralizing”—the woman thought it “strange” that he was not circumcised.
Despite his interest in circumcision, Kesali said he had no one to talk to about pursuing the procedure. But when his 23-year-old wife, Stephania, recently heard a spot on Ebony radio advertising free MC services in Makambako, she urged her husband to look into it. Her reasons had everything to do with her health and that of her family. The couple lives with his family in the Mizani area and has a three-year-old son.
“MC is very good thing to do since it protects one from acquiring diseases including HIV. If my husband gets into a sexual [relationship] with another woman, he will be able to protect himself and also protect us both,” Stephania said. As part of MC counseling, clients like Stephania’s husband are advised that male circumcision used in combination with other HIV prevention measures—including condoms, partner reduction and abstinence—is an important and effective way to prevent HIV.
Stephania also noted that circumcision will help keep her husband clean, “especially when he goes travelling for days without shower.”
Kesali understood that male circumcision helps prevent sexually transmitted infections, including HIV, and he liked the hygiene benefits. After weighing the benefits and impact of circumcision, Kesali decided to visit Makambako Health Center, where he underwent the procedure on the same day (May 18). As part of the service, Kesali was counseled not only on circumcision, but on HIV prevention and male involvement in reproductive health. He was also tested for HIV. He and his wife had been tested before they married and were negative. Kesali characterized the counseling as “very comprehensive,” saying he believed he gained a lot of information on how to live a healthy life.
In June, July and August of this year, the Iringa region will embark upon a large campaign with the aim of providing MC services for an additional 20,000 adolescent boys and men. A widespread advertising campaign will begin in the next few weeks, designed to encourage this population to use these services. “This program will help us reduce HIV in Iringa,” says Iringa Regional Medical Officer, Dr. Ezekial Mpuya. “Male circumcision services will be available at 24 sites across the region during this period, and we hope that the people of Iringa will take advantage of this free and safe service.”
Most Tanzanians participating in the Iringa MC program to date have been adolescent boys and unmarried men. Older men have been reluctant to come forward for many of the reasons and fears expressed by Kesali. But Kesali says public health officials should continue their outreach in his community where circumcision is not practiced, and provide more education so that adult men can make informed decisions about the procedure. “I would like to convince my entire family to get circumcised, too,” he said.
Stephania said women should advocate for their husbands or partners to get circumcised: “Why not?” She said she plans on taking her son to be circumcised when he is older.