This is part two of a posting by Laura Engelman, an intern for the Male Circumcision Consortium at FHI 360. You can read part one here.
Some of the tensions that can arise when MMC is introduced were felt in Kenya when a national VMMC program was launched there. FHI 360 works closely with the Government of Kenya (GoK) on its national VMMC program. This program, launched in November 2008, focuses primarily on Nyanza Province, which has the highest HIV rates in Kenya coupled with the lowest rates of MC. The Kenya VMMC program shines light on the value of community-building and open dialogue when discussing controversies involving MMC.
In order to quell fears about MMC among skeptics of the intervention, GoK officials and the program’s partners held two large forums in Kisumu, Kenya before the official launch of the campaign. Community members and stakeholders at these forums voiced concerns over introducing the medical intervention in a traditionally non-circumcising community. Through honest discussion and a thorough presentation of the facts and the positive randomized control trial results, the GoK and their partners reassured the community leaders that circumcision is a strictly medical, rather than cultural, intervention. Reframing it in this way led to the community’s acceptance and endorsement for the medical procedure.
Similarly, discussing the medical benefits of the procedure with stakeholders in communities that practice traditional circumcision as a rite of passage for adolescents is important in reassuring concerned community members. In these communities, partners are exploring ways in which traditional MC can be made safer. There is also discussion about how other rituals can be combined with medical circumcision so that a rite of passage ritual survives. In addition to community discussion about the procedure, peer-to-peer communication also helps to allay fears about the procedure. One adolescent in Kenya reported that the youth in his community thought of traditional circumcision as a “brutal” practice until one of their friends underwent MMC. After hearing from the trusted friend that the procedure did not hurt, other boys his age opted for the medical intervention.
Adolescents throughout sub-Saharan Africa undergoing MMC receive counseling along with “the cut.” Counseling must be tailored to an adolescent audience to reinforce the idea that MMC is only partially protective from HIV and that other protective behaviors, such as correct and consistent condom use, must also be employed. Counseling must discourage sexual disinhibition after undergoing MMC. Circumcision only provides men with partial protection from HIV and is by no means a free pass to engage in unsafe sex. Though medically circumcised men are 60% less likely to contract HIV from an HIV-positive woman, it is imperative that these men do not counteract the benefits of MMC by engaging in risky sexual behavior. MMC should be viewed as part of a comprehensive HIV prevention package that includes use of condoms, regular testing for STIs and HIV, open communication about sexual behavior and sexual health, and reducing the number of sexual partners.
Through research, communications efforts, and collaboration with other organizations, FHI 360 is working to improve and expand access to safe, VMMC services in sub-Saharan Africa. Kenya’s national VMMC program is the most comprehensive to date and has led the way for others to engage in national VMMC scale-up programs as well.