Increasing Access to Male Circumcision Services | en français

“I am very well prepared and now highly confident in performing male circumcision . . .” says Anna Panduleni Kauko Shilunga, a nurse training manager in Namibia.

In a country with an HIV prevalence rate of over 17%, IntraHealth is leading an effort to decrease HIV infection by working with the Ministry of Health and Social Services to roll out male circumcision services across Namibia. Shilunga, who works for I-TECH, was one of 20 participants in a two-week male circumcision training program that is just one component of the IntraHealth-led Namibia HIV Prevention, Care and Support Program. Funded by USAID, the program aims to build the country’s HIV prevention, testing, care and treatment capacity. Evidence shows that male circumcision can reduce a male’s chances of acquiring HIV—by as much as 60%.

“Given the evidence . . . if the community makes full use of male circumcision, then HIV/AIDS prevalence will definitely come down,” says Dr. Peter Njuki, project manager at Onandjokwe Hospital, from which two medical officers and one registered nurse participated in the male circumcision training conducted by Jhpiego.

The evidence comes from three randomized control trials from sub-Saharan Africa, and the Government of the Republic of Namibia has recognized the important role that male circumcision can play in HIV prevention. Traditional circumcision methods have been practiced historically in Namibia, especially in certain regions. Still, according to the 2006-07 Demographic and Health Survey, Namibia’s male circumcision rate is low, around 21%. Clinical services for male circumcision in Namibia, while largely well-received, are not as readily available as they could be.

“I think the demand for male circumcision was created when the facilities are not quite ready. . . ,” comments Shilunga, who works for I-TECH. “Because so many people are waiting to be circumcised but cannot be accommodated because male circumcision is not being offered on a daily basis.”

“One would say that male circumcision has always been offered in our center. However, it was not being offered as part of HIV prevention package,” adds Njuki.

The program’s plan is to eventually roll out male circumcision services in three tertiary hospitals and one district hospital per region. The participants in the male circumcision two-week training are now skilled in training other providers in the service and will do so in four pilot sites.

“As a nurse training manager,” explains Shilunga, “I will coordinate and train health care workers in the Ministry of Health—together with fellow trainers—and empower them with the necessary knowledge and skills to be able to provide high quality and safe male circumcision in hygienic settings.”

The four faith-based hospitals that are the pilot sites for male circumcision began offering services immediately following the training. IntraHealth will follow up with the hospitals to strengthen the newly acquired skills and knowledge of the trained providers, support the rollout of the program to other facilities and make sure providers are performing the essential services correctly, including sexually transmitted infection screening and management, behavioral counseling, provider-initiated HIV testing and counseling, and condom promotion and distribution. IntraHealth will provide support and monitoring of the providers’ performance and any post-procedure side effects, as well as supporting the supply chain management of needed supplies, and creating demand for male circumcision services.

IntraHealth is a key player in the National Male Circumcision Task Force, which is working toward the scale-up of safe male circumcision services as part of a national comprehensive prevention package. The package also includes education awareness campaigns, information sessions, advocacy work through the media, and assisting the Ministry of Health in creating a national male circumcision strategy with supporting policies and technical recommendations. Other task force partners include members of the Ministry of Health and Social Services, the United States Government, the World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), University Research Company and NawaLife Trust.

Launched in 2008, the five-year Namibia HIV Prevention, Care and Support Program works with Namibian faith-based mission hospitals, nongovernmental organizations and professional organizations to prevent HIV transmission; improve access to HIV testing and counseling; and develop treatment, care and support programs for people living with HIV.