Circumcision offers heterosexual men lifelong, partial protection against HIV, reducing their risk of becoming HIV-infected by 60 percent. This powerful prevention effect has motivated the Government of Mozambique to prioritize the scale-up of voluntary medical male circumcision (VMMC) services, an effort in which ICAP is a leading partner.
With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), ICAP is providing comprehensive assistance to rapidly scale up VMMC in Zambézia, Mozambique’s second most populous province and home to just over 40 percent of all people living with HIV in the country. Since 2013, when the effort began, ICAP has supported conduct of VMMCfor more than 151,000 men and boys.
Guarionex Joel DeCastro, Assistant Professor of Urology at Columbia University, recently visited Mozambique to advise on some of the technical aspects of the program. “The providers in Zambézia do more circumcisions than most urologists, often 10–20 in a day,” reported DeCastro. “The level of proficiency, care, and professionalism I saw there was extraordinary.”
This rapid scale-up in Zambézia has been accomplished through ICAP’s support for needed clinic renovations, the training and mentorship of health workers, and through ongoing monitoring, evaluation, and quality assurance activities. In addition to supporting seven health facilities to provide on-site VMMC services, two fully outfitted mobile clinics also travel to the furthest reaches of the province to bring VMMC and HIV counseling and testing services to distant communities. Given the size and rural nature of the province, the mobile clinics have been critical to meeting the need for VMMC. In fact, the mobile clinics often account for 20 percent of the circumcisions conducted in a quarter in Zambézia.
Another core dimension of ICAP’s work is communicating the benefits of VMMC to Zambézia’s residents to generate demand for the service. “We have spent a lot of time thinking about how to appropriately and effectively convey the message,” explains Juliana Soares Linn, ICAP’s deputy director of implementation. “We use a wide range of approaches; all tailored to the specific age groups to be reached.” Such approaches include mass media campaigns, as well as educational sessions that are held at schools and in communities. To spread the message even further, ICAP is partnering with community-based organizations to raise awareness about VMMC through household visits and community events.
In addition to supporting VMMC scale-up, ICAP is collaborating with the Ministry of Health, CDC, and Jhpiego in the evaluation of the acceptability and safety of the Shang Ring, a disposable device that eliminates the need for suturing during VMMC.
“The successful scale-up of VMMC will have an important impact on control of the HIVepidemic in Mozambique and elsewhere”, said Dr. Wafaa El-Sadr, ICAP’s director. “This compels the need for continued innovation to achieve this goal.”