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NAME OF GOOD PRACTICE: MALE CIRCUMCISIONPRESENTERS NAME:PETRONELLA PULE KAUNGU

CATEGORY: TLOCAL GOVERNMENT COEINSTITUTION: CHINGOLA MUNICIPAL COUNCIL

COUNTRY SADC GENDER PROTOCOL SUMMIT

DATE:24-25TH March 2013

VENUE:CRESTA GOLFVIEW

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BACKGROUND!!

BRIEF DESCRIPTION OF THE GOOD PRACTICE

• Male Circumcision is the surgical removal of some or the entire foreskin (prepuce) from the penis. Male circumcision is one the oldest and most common surgical procedures worldwide, and is undertaken for many reasons, religious, cultural, social and medical. In Zambia, circumcision is traditionally practiced on a large sale only in North-Western province, an area with one of the lowest HIV rates in Zambia, few ethnic groups in Zambia conduct male circumcision as a part of religious and cultural practices. The Luvale and Lunda of North-Western province practice traditional universal male circumcision, though there are small groups who also practice adolescent circumcision in other areas of the country. The relatively small Muslim and Jewish communities also practice male circumcision for religious reason.

• Although male circumcision is not a substitute for safe sex, it is a scientifically proven way of preventing HIV infection in men. In Zambia, despite the awareness campaigns, male circumcision rate remain low. The increase in demand for the service could be an indication of high motivation of the practice in the population. Overall 13 percent of men age 15-49 and 14 percent of men age 30-49 are circumcised.


WHAT IS THE PROBLEM BEING ADDRESSED? WHY?

• Male circumcision addresses the problems of HIV/AIDS has scientifically proven way of preventing HIV infection in men infections and cervical cancer in women.

• Urinary tract infections- circumcision helps prevent urinary tract infections in both males and female partners. Urinary tract infections early in life can lead to kidney problems later. Urinary tract infections account for a large percentage of “unexplained” fevers in uncircumcised males. It is a documented fact that uncircumcised males are 10 times more likely to come down with a urinary tract infection than circumcised males.

• Sexually transmitted diseases and HIV- studies in recent years have shown that the percentage of HIV and sexually transmitted diseases are lower in circumcised males. This is due to the fact that the foreskin causes an environmental conducive to germs if germs are introduced.

• Cancer- a circumcised male is virtually risk-free for penile cancer. However, for the uncircumcised male the chances of coming down with penile cancer are fewer than one in 100,000. Studies have shown that women are at greater risk of cervical cancer with an uncircumcised male partner.

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Men travelling long distant for circumcisionThe Good Practice


HOW IS THE PROJECT CONTRIBUTE TOWARDS ACHIEVING THE 28 TARGETS OF THE SADC

PROTOCOL?


PROTOCOL TARGET ACTIONS

28 Targets of the SADC Protocol on Gender and Development Article 27 HIV and AIDS

This activity has contributed to achieving the 28 Targets of the SADC protocol on Gender and Development, and the relevant Target is Article 27 HIV and AIDS. As a result male circumcision has contributed in achieving the 28 targets of the SADC protocol on Gender and Development in the sense that male circumcision is a scientifically proven way of preventing HIV infection in men

DESCRIBE YOUR TARGET GROUP


YOUTHS: these are major target, as circumcision has been scientificallyproven to reduce risk of contracting HIV vaginal intercourse by as much as60 percent. The forty girls and twenty boys at Kabuta Community schoolKapisha-Chingola. The younger the better, when we educate the young oneswe educate a nation and this will have positively impact on these practices.Women: they is need to be included, it will also be critical to engage womenmobilization of their partners and to ensure that they play a bigger role inVMMC than is done currently.Government: the government is also the target, as government shouldconsider integrating male circumcision into outpatient services in publichospitals, as way of starting infant male circumcision and also increasesensitization and mobilization efforts, the practice should be mademandatory to infants boys

OBJECTIVES


•Designed to promote health citizens in line the SADC protocol on Gender and Development, and the relevant Article 27 HIV and AIDS.•To provide a framework for increasing access and use of safe, and sustainable male circumcision service as an integral part of HIV prevention strategy.•To contribute to the reduction of HIV and other sexually transmitted infections through safe male circumcision.•To produce a healthy and productive population free from HIV infection.•Offer male circumcision services as part of comprehensive HIV prevention package.•Strengthen hospitals to provide male circumcision services•To ensure freedom, voluntary access and confidentiality to male circumcision services in health facilities.•Ensure that men are aware that circumcision is the key to the reduction of cervical cancer and HIV infection. •Raise awareness on the twenty eight targets of the SADC protocol.•Ensure that there is full participation and involvement of civic leaders and stake holders and communities.

PROCESS

• The different steps of activities in the implementation are sensitization counseling, reporting and commitment. Sensitaization being the most important part of male circumcision, the is urgent need for male to fully understand the process of and its benefit of this activity such as Cleanliness, it is easier to keep a circumcised penis clean.

• Urinary tract infections- circumcision helps prevent urinary tract infections in both males and female partners. Urinary tract infections early in life can lead to kidney problems later. Urinary tract infections account for a large percentage of “unexplained” fevers in uncircumcised males. It is a documented fact that uncircumcised males are 10 times more likely to come down with a urinary tract infection than circumcised males.

• Sexually transmitted diseases and HIV- studies in recent years have shown that the percentage of HIV and sexually transmitted diseases are lower in circumcised males. This is due to the fact that the foreskin causes an environmental conducive to germs if germs are introduced.

• Cancer- a circumcised male is virtually risk-free for penile cancer. However, for the uncircumcised male the chances of coming down with penile cancer are fewer than one in 100,000. Studies have shown that women are at greater risk of cervical cancer with an uncircumcised male partner.


WHAT HAVE BEEN THE MAIN SUCCESSES?

• Male circumcision has turned to be a highly cost-effective strategy for hiveprevention for Zambia context. A recent assessment of the potential impact andcost scaling up male circumcision in Zambia found that expanding male coverageto 80% of adult men and boys by 2015 would avert an estimated 486,00 new HIVinfections (approximately 50% of all new infections) and would result in acumulative net saving for the public health sector of US$ 2.4 billion between2009 and 2025. Evidence suggests that Zambia National male circumcisionprogramme have the greatest and most immediate impact by focusing on HIVnegative adult males age 15-49. Nonetheless early infant male circumcision(EIMC) is recognized as essential to the sustainability of the risk of transmissionof HIV from women to men has been well documented in southern Africa andsupporting evidence for sustained effects from follow on cohort studiescontinues to emerge circumcision in preventing HIV transmission form women tomen to be significantly greater than any HIV vaccine developed to date.


KEY OUTPUTS (MATERIALS ETC.)


• BEFORE Condemned tissue in orange AFTER Flaccid in each case

• Almost all the inner foreskin has been removedalong with an equal amount of outer foreskin. Notension has been placed in the shaft skin, with theresult that the flaccid penis droops and the sulcus isnot held fully open. Thus, despite circumcision, itremains possible for smegma to accumulate


KEY OUTCOMES (MAIN RESULTS)• The main out puts has been , sensitization, information basing on the problem of

male circumcision as a preventive way of new HIV infection and cervical cancer in women because of this our government has made a deliberate policy under the ministry of Health for Voluntary male circumcision services in major health centers throughout the country. Zambia continues to face a health, economic development, and humanitarian emergency as a result of the HIV/AIDS epidemic, high HIV prevalence rate in Zambia (14.3%) has sent a strong message on the need to implementation of comprehensive HIV prevention strategies such as male circumcision. As the main entry point to HIV prevention, care and support, and treatment services, HIV testing and counseling is central to all HIV programmes national wide including male circumcision. Male circumcision has provided incentive rewards for effective prevention of new HIV infections. HIV prevalence levels have decreased due to male circumcision. Male circumcision has improved the quality of life by reducing new infections such as urinary infections, cervical cancer and STIs and has also improved the national inventory stock management system. Male circumcision has reduced HIV incidence in young people, male circumcision practices in Zambia have lowered HIV prevalence. The results showed that 14 percent of uncircumcised men were infected, compared with only 3.9 percent circumcised men. It has also that protective effect against HIV was due to male circumcision because such as religion and ethnicity are associated with male circumcision and also have a major influence on HIV.


CHANGING LIVES

• Saving the Kaonde Nation through male circumcision.

His royal highness, Chief mumena XI of the Kaonde Nation,has testified that male circumcision has been seen as eithercultural aspect of making the passage to manhood of a manor as a medical practice of preventing HIV infections andhygiene. As Chief Mumena said, circumcision prevents 60%of HIV infection. I had circumcision when I was on my sixthgrade. When I was young, I developed rashes around myprivate area during summer-the perfect time forcircumcision. Chief Mumena, the consequences are highand this prompted him to step up in leading the men in histribe to submit to circumcision by setting an example-himundergoing circumcision.


LESSONS LEARNT

I have learnt that the message of male circumcision as the key in prevention ofHIV new infection is not well received and understood by men before the start ofthe programme. Counseling should be an integral element of the MCintervention, and trained counselors should be made available in health facilities.A successful male circumcision service delivery depends on a goodcommunication. Getting civic leaders involved should be the first thing to be donebefore the start of the programme has this is key to the success of malecircumcision because entry in the community will not meet any resistance. Thesanitized leaders should also assist by becoming resources in the community; theyare supposed to be reference point on male circumcision in their communities(for instance chief Mumena of Kaonde people of Solwezi North –Westernprovince of Zambia). Use of youth centres is important to reach out to youth withHIV prevention, care and support service through sports. It is important to firstunderstand the myths in the community to be able to correct the situation. Thequality and availability of services is key to a success of male circumcision roll out.Care needs to be taken to minimize adverse events like excessive bleeding. Propermanagement and follow up during the post circumcision period helps inmanagement of pain after circumcision. A negative reaction due to poorunderstanding of circumcision in the community


WAY FORWARD

• The way forward is that the project will continuebeyond its current life spa by holding focus ofeducation and sensitization and interacting of theimplementing and the victims regularly. TheGovernment of the Republic of Zambia has also madepart of the health programme to make sure that malecircumcision been incorporated into the allprogramme and be found yearly. The Ministry ofHealth has also opened up more centres in rural areasto meet the need of the people. The government hasensured that male circumcision as part of nationalcomprehensive HIV preventive strategy.


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