Tanzania’s voluntary medical male circumcision (VMMC) program, AIDSFree, has made incredible progress since its inception in 2009. In partnership with John Snow Inc.,and through the sponsorship of the United States President’s Emergency Plan for AIDS Relief and the U.S. Agency for International Development (USAID), Jhpiego is working with the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children to rapidly expand the provision of high-quality, client-centered VMMC services as a core component of comprehensive HIV prevention services.
The program provides VMMC services in five regions of Tanzania—Iringa, Njombe, Tabora, Morogoro and Singida—and this year saw its 800,000th client, 16-year-old Clinton Msambwa from Njombe Region. The program’s goals are to increase circumcision coverage of males ages 10–34 to 80% and develop sustainable strategies to maintain that coverage, including through early infant male circumcision.
Clinton was raised in a village where most did not support circumcision. He said that some compared it to witchcraft, while others believed it reduced life span.
In September 2017, his older sister and guardian, Atukuzwe, saw the positive outcomes of VMMC firsthand in her nephews. She shared that information with Clinton and suggested he consider the procedure. The sister took Clinton to Makambako Hospital, where he met with counselor Goletha Kihungu. The counselor discussed the package of HIV prevention services available to Clinton, citing the health benefits of circumcision– protection against acquiring HIV and other sexually transmitted infections – and the risks of the procedure. She also dispelled the myths about VMMC that Clinton had learned in his home village, providing him with the facts to make an informed decision about VMMC.
“It was not easy for me to agree at first. It took some time. When I was counseled is when I made my decision,” said Clinton.
Clinton had the procedure in January 2018.
“They explained to me that these services are done by professional medical personnel,” he said. “Hundreds of people had already received the service without any effects,” referring to the rumors mentioned by the people in his village.
Goletha has worked with many men in Clinton’s position. “It has been a challenge, but whenever they come, we try as much as we can to offer the best advice so they can drop these myths and beliefs they have held for so long,” she said.
After Clinton had the procedure, he went back to his village, where he now advocates for all men to undergo VMMC.
“In this society, there are elder brothers who are not circumcised and will defend that. What I do is try to find a chance with them, one on one, and educate them the way I was educated,” he said.
VMMC in Tanzania
In 2017, approximately 734,625 people underwent VMMC nationwide. Between January and November 2018, 808,778 clients had already had the procedure.
The AIDSFree program builds upon the successes of USAID’s Maternal and Child Health Integrated Program and Accelovate to scale up VMMC in Iringa, Njombe and Tabora regions. In October 2017, in collaboration with USAID and the National AIDS Control Program, AIDSFree expanded its support to Morogoro and Singida regions.