DODOMA, Tanzania — A PEPFAR-sponsored program for AIDS relief has provided 100,000 free, voluntary medical male circumcisions in Tanzania since its founding in 2009. Models estimate that this will prevent approximately 16,000 future HIV infections between now and 2025.
The program’s efforts are focused in Iringa and Njombe, the two cities with the lowest rates of male circumcision and the highest rates of HIV in Tanzania.
Partners in the project include the Tanzanian Ministry of Health and Social Welfare, UNAIDS and Jhpiego — an affiliate of Johns Hopkins University.
Voluntary Medical Male Circumcision (VMMC) reduces men’s risk of contracting HIV through heterosexual intercourse by nearly two-thirds. However, for men already HIV-positive, the procedure does not reduce their risk of transmitting the disease to their partners.
Along with the reduction of HIV in the Tanzanian population, the VMMC program also provides other benefits. Studies show that the procedure can reduce the contraction and transition of certain sexually transmitted infections, including herpes and syphilis. It also benefits women because it decreases a woman’s risk of coming into contact with an HIV-positive man. VMMC also cuts the rate of HPV in men, which is associated with cervical cancer in women.
The program is not limited to conducting the procedure alone. The World Health Organization also recommends patients undergo HIV prevention training. This training includes HIV testing and counseling, screening and treatment for sexually transmitted infections, availability of male and female condoms and the promotion of safe sexual practices.
Although VMMC is designed to target the male population in Tanzania, women also play a crucial role in the success of the initiative. A total of 70 percent of the health providers who work with the program are female nurses. Other women provide education and counseling, while wives encourage and often accompany their husbands for the procedure.
In addition, male circumcision is increasing men’s access to health care facilities and their willingness to accept care. In areas such as Iringa and Njombe, where men are traditionally opposed to approaching health clinics, there are increasing numbers of patients willing to ask for medical help.
The VMMC initiative was recently popularized by a documentary at the 2014 Zanzibar International Film Festival. The PEPFAR-funded film “It’s About the People: Tanzania’s VMMC Program Gets it Right” documents the success of the program in decreasing the Tanzanian population’s risk of HIV/AIDS.
To emphasize the risks and benefits presented by the rapid scaling up of VMMC, the film follows the story of 34-year-old Yohana and his family living in Njombe. After witnessing the death of several close friends and family members to AIDS, Yohana and his son undergo the procedure.
Yohana’s story is one of safety and protection for himself, his wife and his son. Yet the tragic events that led to his decision can be avoided if the program continues to expand and gain patients. The next phase for the success of the initiative is an acceleration of circumcision services in other regions of Tanzania and a new focus on early infant male circumcision — a key component of sustainable HIV prevention.
– Mari LeGagnoux
Sources: USAID, All Africa, Jhpiego
Photo: PSI Healthy Lives