Lare, Ethiopia—When his three sons prepared to leave home to attend university, James Jieng felt it important that they were medically circumcised to help protect them against HIV.
Jieng, a 50-year-old nurse at the Lare Health Center, encouraged his sons to have the procedure even if it meant delaying it for himself.
“My sons were circumcised before they joined university,” he said. “They did this after knowing it will reduce their risk of getting HIV and other STIs [sexually transmitted infections] as they may be more prone as they go away from home.”
Only after his sons were circumcised did Jieng go to the same health center at which he works to be circumcised.
He explained, “I wanted the procedure to be healthy and promote my personal hygiene. I have learned that it will protect me from different sexually transmitted infections, including HIV.”
Since 2008, countries across sub-Saharan Africa have been engaged in a comprehensive HIV prevention strategy to reduce the spread of AIDS; a central component of the strategy is voluntary medical male circumcision (VMMC) services. Studies have shown that VMMC reduces female-to-male HIV transmission by approximately 70 percent, making it one of the leading prevention interventions under way.
In some cultures in Africa, circumcision is part of a traditional or religious rite of passage for youth and performed by tribal leaders.
In Ethiopia, male circumcision is widely practiced by both Christians and Muslims. However, that was not the case in the Gambella region, which borders South Sudan in Ethiopia’s far west and has the highest HIV prevalence in Ethiopia. In Gambella, where the Jieng family lives, medical male circumcision is still a relatively new and underused practice.
Jhpiego has been working in the Gambella area since 2008, promoting VMMC as part of a government-supported comprehensive HIV prevention strategy. As of April 2016, more than 61,043 men have obtained quality VMMC services for free. Because the Jhpiego-supported program is free, Jieng was motivated to have his sons undergo circumcision before leaving home: they would have to pay for the procedure elsewhere in Ethiopia.
The project was funded by the United States President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention (CDC) and the International Center for AIDS Care and Treatment Programs (ICAP). Jhpiego has collaborated on the project with the Ethiopian Federal Ministry of Health, the Gambella Regional Health Bureau (RHB), the Surgical Society of Ethiopia and other organizations that have promoted male circumcision in Gambella since 2008.
Moses Hoth, a nurse with 5 years’ experience in the VMMC program at the Lare Health Center, said fear of circumcision used to be widespread in the community, prompting resistance to the procedure.
That resistance has lessened, Hoth continued, in part because of the educational leaflets and posters that Jhpiego has printed in local languages. Other efforts have included town criers and radio announcements. Also, health extension workers, who are trained to provide basic health care, attended a male circumcision orientation organized by Jhpiego and the RHB.
Hoth also said that the STI rate among circumcised clients has decreased at the Lare clinic. “We used to treat at least five clients per week with STIs in Lare Health Center before the facility started provision of male circumcision services, but now we rarely get one client a week,” he said.
“The RHB, CDC, ICAP and Jhpiego have benefited our community in many ways, especially in preventing female-to-male HIV transmission, increased uptake of HIV counseling and testing, and early detection and treatment of STIs,” he said. “They have also renovated our minor operation room, trained four of our staff on how to perform the procedure and provided us with sufficient supplies and medical equipment.”
In Ethiopia, Jhpiego works in the Gambella region only. The district was selected after the 2005 Ethiopia Demographic and Health Survey indicated that the male circumcision rate there was just 46 percent, but the HIV prevalence rate was 6.5 percent, three times the national average.
Ethiopia (based on data in the Gambella region) is considered among the 14 priority countries identified in eastern and southern Africa for VMMC. Modeling suggests that achieving and maintaining a male circumcision rate of 80 percent in these 14 nations would prevent 3.4 million new HIV infections by 2025.
To reach the 80 percent mark in Gambella, about 106,075 adult males (age 10 and older) must be circumcised by 2019, according to Ethiopia’s national VMMC technical working group.
As for Jieng, he said he now plans on doing all he can to raise awareness about the benefits of male circumcision among the youth of his district. He said he’ll start by visiting churches, schools and other places where male adolescents gather.
“I would like to thank the RHB and partners for giving my family and community this opportunity and free access to the service, which otherwise would have been difficult,” he said. “We are safe and protected.”