Thyolo, Malawi—When the outreach roadshow advertising free male circumcision services arrived in the village of Helimani, Kizito Liyasi was curious enough to attend an information session. A grocer with a wife and baby boy, Kizito was moved by a man’s personal decision to be circumcised as part of a comprehensive strategy to prevent the spread of HIV. He headed home to discuss the free health service with his wife.
Along the way, he met several male friends who dissuaded him from undergoing the procedure, arguing that he didn’t need to be circumcised because he was married. Kizito’s wife, Triza, saw it differently, sharing with him the health benefits of circumcision that a local nurse had explained to her. A group education session at the nearby Ntambanyama Community-Based Organization (CBO) provided further information for the 20-something father. Together, he and his wife decided that voluntary medical male circumcision (VMMC) was right for their family. “I was convinced I needed to do this,” he said.
Kizito is among the 3,416 men who were circumcised during the three-week, Jhpiego-led VMMC campaign in Thyolo District this spring. The campaign was implemented under the U.S. Agency for International Development’s Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego, in collaboration with the Malawi Ministry of Health and the Christian Health Association of Malawi.
Kizito is older than most of the clients who participated in the services held at Thyolo District Hospital, Malamulo Mission Hospital, and Nkusa and Ntambanyama CBO centers. But, as he rightly stated, age shouldn’t be a factor in choosing VMMC. “It is not about how old you are, as for me, it is about focusing on the high benefits of circumcision. It’s never too late for my hygiene and safety,” said Kizito, who queued up for services with the younger clients and talked with them during the group education sessions. “It’s just the right time. I can protect my wife from cervical cancer. It’s more than a choice to me. It’s a responsibility.”
For Kizito, the convenience of getting the service at the local Ntambanyama CBO—an outreach site near his home and a place that is not a regular health facility—added to his motivation. “It is like the hospital came to my village. I couldn’t ask for more with the service available for free. I knew I could easily walk a short distance back home after the procedure. In a way, you can say it is like I have been circumcised at home,” explained Kizito.
The campaign’s innovative and comprehensive approach to circumcision and the input from his wife jointly influenced Kizito. The group education sessions he attended dispelled myths about circumcision he had heard and educated him on VMMC’s health benefits. “All my life I had never thought about getting circumcised. What for? It was not part of my culture and religion,” said Kizito, adding that stories and hearsay linked circumcision to sexual pleasure and certain cultures and religious sects.
But the conversation with his wife proved most persuasive. To Kizito’s surprise, Triza had no reservations. She was happy to encourage him and even shared her knowledge about the benefits of male circumcision:
“During one of my antenatal visits, the nurse at the hospital was teaching us about cervical cancer. She mentioned that male circumcision helps reduce the chance for cervical cancer as well as penile cancer and, most importantly, HIV … I never told my husband then because I was not sure how he would take it. He might have been angry with me. I was also worried about agreeing to pay around 1,500 Kwacha for the service at Malamulo [Hospital] while we are struggling to get other daily necessities in our home. Now that he initiated the issue himself and that the service is being offered freely and near, I encouraged him to go for it for the safety of our family.”
Kizito Liyasi’s successful participation in the VMMC campaign in Thyolo is a testament to a married man’s motivation in choosing circumcision, family decision-making and a uniquely organized campaign to deliver services, most significantly, at community-based outreach service points in the catchment areas of the static sites. With most of the villages located far from the hospital-based sites, the community-based outreach sites made it more convenient for most clients and created a local excitement about the campaign. This innovative approach also helped to reduce chances of high client turnover at a single site, which could likely affect the quality output of the providers.
The “doorstep delivery” setup to deliver circumcision services through community-based, temporary sites proved the clincher for Kizito, who likened it to “getting circumcised at home.” The convenient, innovative and intimate approach led to the campaign significantly exceeding the initial projected target of reaching 2,500 clients—ultimately providing VMMC services to more than 3,000 males in just 21 days.