27 March 2014: Promoting Voluntary Medical Male Circumcision among adolescents and youth to reduce the risk of HIV
By Sabine Brandenburg
Makete district, Njombe region, United Republic of Tanzania, 27 March 2014
The atmosphere is alive and festive. Men and women, boys and girls from different villages are gathered today at Ivalalila ward in Makete district to attend a theatre performance organized by Support Makete to Self Support (SUMASESU), a local non-governmental organization.
During the show, artists play songs, dance and role play around the theme of voluntary medical male circumcision (VMMC) and the fight against HIV and AIDS. Young people in the audience laugh and cheer. “I heard about this event at the peer education club I attend every week”, says 20 year-old Ahimidiwe S. Mahenge. “I think it is a key step to win people over and to take all their doubts away.”
Makete district is located in Njombe region in the Southern Highlands, which has the highest HIV prevalence in the country at 14.8%, compared to the national prevalence of 5.1%.
Preparing the community of Makete for VMMC
In 2006, the World Health Organization announced that there is now compelling evidence that male circumcision can reduce the risk of a man contracting HIV from unprotected vaginal sex by 60 percent. As part of a much larger effort to scale up VMMC in 14 countries in East and Southern Africa, Jhpiego – an affiliate of Johns Hopkins University, has been providing support to the Njombe regional authorities to scale up VMMC for the past four years. Recently, UNICEF and Jhpiego teamed up with SUMASESU to sensitize and mobilize adolescents and young people, their families and community leaders in 20 of the 97 highly HIV-affected villages in Makete district about VMMC, while Jhpiego made VMMC services available to the youth and men inspired to seek VMMC services.
VMMC services are delivered as part of a package of services that include HIV testing, screening for sexually transmitted infections, physical exam, medical circumcision, provision of condoms, and HIV risk-reduction counselling.
VMMC has not been a practice customary to the community of Makete, so there has been some ground work to be done. With the help of SUMASESU, the ward executive officers organised a workshop for influential people. Local government leaders, village leaders, religious leaders, teachers, peer educators and youth clubs were invited. The workshop provided a platform to get informed about VMMC as a means to reduce the risk of HIV infection, discuss and strategize on how to take part on sensitizing and mobilizing adolescents and men in the community to undergo circumcisions.
Maria Karinga, 24 years old, a workshop participant and peer educator trained by SUMASESU, feels confident to inform participants of the peer education clubs about HIV testing and counselling, condom use, VMMC and other life skill subjects. Originally, sensitization efforts were targeted at young males. But in practice, women have tremendous influence to convince males of different ages to undertake VMMC. As a result, peer education sessions are also highly appreciated by women.
“I was trained by SUMASESU on sexual reproductive health. I feel like an expert now. The peer education sessions are popular. Every week there are around 30 active participants, nearly half of them are women and girls. The people of the village are seeing me as an expert. They come to me for advice on HIV prevention and other life skill subjects.”
Besides peer education sessions, the messages on VMMC is spread through bi-weekly workshops, dissemination of leaflets, posters, broadcasting of local radio announcements and theatre are performances.
Boosting the demand for male circumcision
“After an awareness activity like today’s theatre performance at the Ivalalila village, the demand for VMMC increases significantly. Families and their children stand in queues at the health centres to undergo the service. We work closely together with Jhpiego and the Njombe health authorities to have enough clinicians and counsellors available to perform the surgery and conduct HIV testing and counselling. And to meet the special needs of our older clients, who may prefer a more private setting, clinicians are willing to perform the surgical operation 24h a day”, says SUMASESU director Egnatio Mtawa.
“UNICEF Tanzania supports different high impact HIV prevention interventions targeting adolescents, of which SUMASESU is (one of) the implementing partners. The strong collaboration among UNICEF, SUMASESU and Jhpiego, is a great example of partners coming together to support Government to deliver an evidence-based intervention, VMMC, proven to reduce a man’s risk of acquiring HIV through heterosexual intercourse by at least 60 percent,” says Alison Jenkins UNICEF Tanzania Chief HIV/AIDS.
“The future is bright. People are now knowledgeable. Five years ago, people didn’t want to talk about it, but now they speak out loud and spread the word. If we continue like this and keep raising awareness, all men will be circumcised and we can start hoping our district will become HIV-free in the future”, says SUMASESU director Egnatio Mtawa.
 Tanzania HIV and Malaria Indicator Survey (THMIS, 2011-12)