AIDS 2008 – Mexico City 3-8 August 2008 - XVII Internationnal AIDS Conference

Male Circumcision for HIV Prevention--Scaling-Up Service Delivery and Community Education in Africa and Caribbean	THSB18

Organiser:

Type:

Skills Building Workshop

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Venue:

SBR 8

Interpretation:

None

Time:

14:30 - 16:00, 07.08.2008

Code:

THSB18

Co-Facilitators:

Kelly Curran, United States
Inon Schenker, Israel (Facilitator)

Dudu Simelane, Swaziland

This highly technical workshop will explain and demonstrate to managers and practitioners how to apply the science proving that male circumcision could reduce heterosexual HIV infection in men by up to 60% to policy and practice at the community level. "Operation Abraham" - a Jerusalem AIDS Project model for technology transfer and training in adult and neonatal male circumcision for HIV prevention will be shared, with lessons learned from a first pilot in Swaziland and on-going consultations with other African nations. Participants will walk out with a package of knowledge, skills and educational materials on Community Clinic Based male circumcision for HIV Prevention Service (CCBMCS) scale up.

Presentations in this session:

14:30
THSB1801 Male Circumcision for HIV Prevention--Scaling-Up Service Delivery and Community Education in Africa and Caribbean
Inon Schenker, Israel
Dudu Simelane, Swaziland

Rapporteur report

Leadership report by Richard McKay
Daniel Halperin of the Harvard School of Public Health spoke first on the critical importance of circumcision in HIV prevention, but emphasised that it is not a magic bullet. Behaviour change is still the most important intervention, but adjunctive prevention methods remain vital. A lethal cocktail (the lack of circumcision combined with multiple concurrent partnerships) is thought to be sustaining the pronounced epidemic in southern Africa. Further evidence presented showed a strong link between countries with low circumcision rates and high HIV prevalence, and the same evidence in regions within countries. Halperin concluded by suggesting that male circumcision offered very significant protection for the female sex partners of circumcised men.

Kelly Curran spoke next on the lessons learned from a pilot project of introducing male circumcision services in Zambia between 2003-2005, which sought to explore approaches to make high-quality, comprehensive (including counselling) Male Circumcision (MC) services more available and to see whether the service could serve as an entry point to the health system for male community members. The dorsal slit method was selected since most existing practitioners were already using this method, and the training programme was competency-based, with participants being required to pass exams. The pilot experienced low adverse events rates and was considered to be a successful implementation of male circumcision services in a “real-world” setting.

Inon Schenker then addressed some questions about international collaborations in MCT in Swaziland. He discussed who should be trained (MDs, clinical officers, nurses, all staff and “HIV/AIDS Educators”), who could be suitable trainers (experienced surgeons, experienced clinical officers, nurses, and Iraeli surgeons), why Iraeli surgeons as trainers (Israel experienced the arrival of thousands of immigrants, 60% of whom wanted to be circumcised, and the country has carried out 80,000 of these operations since 1989), why Swaziland (high HIV prevalence and interested in male circumcision), what is “Operation Abraham” (an effort to respond to requests from African countries interested in rapid scaling-up of circumcision efforts), what went right (client-turnover time was reduced by 50%, client intake increased to 10 a day), and where do we go from here (enhancing community service delivery, intensifying client education, and developing closer collaboration with donors and interested organisations).

The next speaker from Swaziland outlined the development of a programme of male circumcision in her country. She emphasised that her group still spends a good deal of time providing information about male circumcision. She highlighted the challenge that her small organisation faced in terms of human resources for meeting the demand.

The final speaker, Brendan C. Bain of the University of West Indies, offered some Caribbean perspectives on male circumcision. He presented the Caribbean’s high position in the worldwide ranking of new HIV infections as a reason to join with Africa in considering male circumcision as a prevention method. He then presented the results of a survey he had conducted with representatives from other Caribbean countries about whether there was any public debate about the intervention (none), policy in development in their countries (none), or fear/myths about the process. On this last point, Bain noted that some men feared that the process would make them less sexually potent, while others, although not scared of the procedure, were worried that they wouldn’t be able to afford it. He also presented anecdotal evidence suggesting that many of the region’s paediatricians, who were trained in the UK, followed that country’s lead in tending not to circumcise.

Questions from the audience included a request for a response to the suggestion that male circumcision would actually be worse for women because it would create a false sense of security for circumcised men and lead to less condom use, a query about how the public and private sectors were involved in the scaling up of MC, and requests for more information about the costs of programmes. A final audience member suggested that circumcision would be an easier sell in the Caribbean if it wasn’t explicitly linked to HIV prevention, but also to preventing cervical cancer and other conditions.