DODOMA, Tanzania — Tanzania has successfully met the WHO target of 80 percent coverage of voluntary medical male circumcision. This incredible success in HIV prevention in Tanzania was accomplished through clinical, community and technological collaboration.
Voluntary medical male circumcision – also known as VMMC – is a safe, cheap and effective means of heterosexual HIV prevention. While the procedure sometimes suffers from a lack of public acceptance, it has been proven to reduce female-to-male transmission of HIV up to 60 percent.
UNAIDS and WHO chose 14 countries in Southern and Eastern Africa to implement a rapid, large-scale HIV prevention initiative, aiming to perform VMMC in 80 percent of the male populations in each nation. This extent of coverage would prevent nearly 3.5 million new infections by 2025.
The program has experienced variant levels of success among different countries due to regional social stigma, lack of infrastructure and clinical ineptitude. Due to mobile outreach campaigns and the implementation of GIS technology, Tanzania successfully reached the mandated VMMC target.
HIV prevention in Tanzania is critical, particularly in the regions of Iringa, Njombe and Tabora, which report the highest prevalence of the virus. The program is experiencing sustainable success, as clinicians continue to perform 35,000 circumcisions a month in Kenya and Tanzania.
VMMC is a strategic and cost-effective investment, for it doesn’t amass the ceaseless costs of antiretroviral therapy. As VMMC averts HIV transmission, the one-time operation has the potential to save the equivalent amount of US $16.5 billion in HIV treatment costs in the 14 targeted countries.
In 2013, the WHO developed PrePex: a surgery-free circumcision device for use in low-resource areas. PrePex is a compressive elastic ring, worn for a week, that can be positioned by mid-level health care workers. Without the need for a local anesthetic, the ring hinders the flow of blood to the foreskin, successfully killing the tissue. This innovation greatly increases access to VMMC, allowing for the expansion to areas without medical infrastructure.
In Tanzania, VMMC was initially met with hesitance. Women – armed with the knowledge that VMMC reduces both HIV transmission and cervical cancer – changed the community stigma. Women pressured their male partners and relatives to join the health campaign, resulting in more than 530,000 Tanzanians choosing to circumcise.
To increase HIV education and community outreach, aid organizations have implemented traveling campaigns, radio segments, cultural performances and standard fixed-site delivery methods in Tanzania.
The traveling campaigns use GIS technology to gather geocoded data on topography and demographics, allowing for a strategic choice in the location of the VMMC delivery. Due to digital map data, service has now reached 98 percent of eligible males in Iringa and Njombe.
While VMMC is an essential component of HIV prevention in Tanzania, the procedure needs to be included in a comprehensive public health response in order to maximize efficacy.
Alongside circumcision, health campaigns need to provide HIV testing and counseling, education on sexually transmitted infections and guidance on condom use, as many community members mistakenly believe circumcision is an acceptable protective substitute to contraceptives.
Voluntary medical male circumcision is a successful and important aspect of HIV prevention in Tanzania. Any country with high rates of HIV transmission and low levels of circumcision should consider VMMC as a critical element of their own HIV prevention initiatives, encouraged by the success story of Tanzania.
– Larkin Smith