Baltimore, Maryland – A Jhpiego-supported HIV prevention campaign provided circumcision services to more than 10,000 men in Tanzania in just six weeks, far exceeding its goal and potentially averting 2,000 new HIV infections.
Jhpiego, an international health non-profit and affiliate of The Johns Hopkins University, worked with regional health officials in Tanzania to carry out the six-week campaign to meet the high demand for this HIV prevention intervention among adolescents and men between the ages of 10 and 49. The campaign ended July 31.
The results show that rapid scale-up of circumcision services can be done safely and as part of a comprehensive HIV prevention package. During the campaign, 99 percent of clients were counseled and tested for HIV and provided with key information about HIV prevention; the men were also provided with screening for sexually transmitted infections and with condoms. The public health impact of a campaign such as the one in Iringa province is measurable: experts estimate that for every 10,000 men circumcised in Iringa, more than 2,000 new HIV infections will be averted.
In Africa today, medical circumcision is being performed as part of an ever-expanding HIV prevention strategy that includes testing and counseling, screening and treatment for sexually transmitted infections, and distribution of condoms. Male circumcision has been recommended by the World Health Organization (WHO) and UNAIDS as one of the key interventions to prevent HIV/AIDS.
Male circumcision, one of the world’s oldest medical procedures, is the removal of the foreskin of the penis. Scientific studies have shown that men who are circumcised are about 60 percent less likely to be infected with HIV during heterosexual sex than men who are uncircumcised.
That’s the reason why some African health officials are looking for innovative and creative ways to increase access to medical circumcision in eastern and southern Africa—the more men who are circumcised, the greater the chance of preventing new infections and halting the spread of the disease.
With support from the U.S. Agency for International Development, Jhpiego worked with regional medical officials to design the public health campaign in Tanzania’s Iringa province, where the organization has been working for eight years. The province has the highest prevalence of HIV of any region in the country—16 percent of adults are living with HIV—and one of the lowest circumcision rates.
Working in conjunction with regional health authorities and several other partners, Jhpiego trained 100 doctors, nurses and HIV counselors for the project, developed client education and counseling materials, and set up five high-volume male circumcision sites in public health facilities in Iringa.
“The Iringa campaign is a great achievement for Tanzanians,” said Dr. Leslie Mancuso, Jhpiego’s President and CEO. “Health officials there, with assistance from Jhpiego, have moved their HIV prevention efforts forward with commitment and perseverance.”
The five sites were two public hospitals, a Catholic mission hospital, a public health center and a Unilever-sponsored health clinic on a tea estate. The campaign got under way after school let out in June and when plantation work was slow. The original goal was 6,000 circumcisions over six weeks. However, overwhelming demand from the surrounding communities resulted in more than 10,000 men receiving circumcision services.
A series of radio ads, posters and flyers produced with input from community groups and local health officials helped generate public interest. The campaign kickoff included traditional African dances performed to a chant promoting medical circumcision.
“On the first day, there were long lines outside health clinic doors,” said Kelly Curran, Jhpiego’s Director of HIV and Infectious Diseases.
“This campaign has allowed the clients to have more than one service at the same time—health education, HIV testing and circumcision. Through this, clients can benefit from different angles. I think it has been quite successful,” added Dr. Yusuf Sasamalo, one of the physicians who performed the circumcisions.
Majudi Maligita, a 30-year-old security guard, learned about the free circumcision services through a radio ad. Circumcision is not customary in Iringa region and yet some uncircumcised men find they are not always in similar company.
“I had to go for training in the army and we went to bathe as a group. It was very stressful to bathe because I was not circumcised and others would talk about that,” said Maligita.
“I thought of doing circumcision since I was very young but my father passed away and my mother could not take me,’’ he said. “In 1999, I had an STI (sexually transmitted infection) and when I went for treatment I was advised to be circumcised so as to decrease my chances of getting sick.”
But Maligita said he couldn’t afford the cost of a circumcision. The Iringa campaign’s cost-free service made it easy for him to participate. He said he would encourage others in his security guard company to have the procedure.
Anton Sanga, 32, said he was encouraged to have a circumcision by several friends and his girlfriend. The couple has been tested for HIV throughout their relationship and currently both are HIV-negative.
“I am very happy with these services,” said the security guard. “I was also impressed with the time used. I was educated, counseled, tested and went directly to be circumcised. I would like to encourage fellows my age to come for these services.”
The Iringa circumcision campaign shows “there is extremely high demand—and unmet need—for male circumcision in areas of Tanzania that do not traditionally circumcise,” said Hally Mahler, Male Circumcision Program Director for Jhpiego. “The leadership of regional and district health authorities, incentives for providers and the cooperation of the local facility managers all made this a success. This pilot project shows that circumcising several million Tanzanians over the next five years is achievable with the right program.
“That’s what it will take to protect Tanzanians at risk for HIV with this intervention.”