In 2007, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended that countries with high-HIV prevalence and low rates of male circumcision scale up access to voluntary medical male circumcision (VMMC). Uganda endorsed this recommendation and developed the Safe Male Circumcision Policy in 2010 to increase access to and use of safe and sustainable male circumcision services as an integral part of the national HIV-prevention strategy. Despite the fact that free VMMC services have been available since 2010, uptake in Northern Uganda remains disproportionately low.
The USAID-funded Regional Health Integration to Enhance Services-North, Lango (RHITES-N, Lango) project promotes and facilitates VMMC as part of its comprehensive HIV-prevention strategy. Recently, RHITES-N, Lango used a multipronged, data-driven approach to reach almost 20,000 young men with VMMC services in three months.
Young men may choose not to have the procedure for a variety of reasons. They may have misconceptions about change in sexual drive or performance associated with circumcision, believe misinformation about HIV prevention, and/or live in a community that stigmatizes the procedure. They also may not have access to VMMC services because they do not live near a facility with trained staff or required supplies. Alternatively, young men may deem the procedure inconvenient if it affects their work or school schedule.
RHITES-N, Lango considered all these factors when designing its approach. First, the VMMC team looked at the most recent lot quality assurance sampling report to identify the districts where the services was least used. The team also looked at previous data and determined that VMMC uptake rates were higher at the end of a school term. Using this information, RHITES-N, Lango worked with district VMMC focal persons to map when and where to scale up VMMC services.
Once the team knew where to provide services, they worked with the RHITES-N, Lango social and behavior change team, district health educators, and people living with HIV networks to identify and orient peers and village health teams to basic VMMC messages (adapted from the USAID-funded Communication for Healthy Communities project) and interpersonal communication (IPC) skills. Once trained, these “IPC agents” met with members of their communities, visited trading centers known to be popular meeting places, and organized sessions at schools, prisons, and health facilities to talk with young men about the benefits of and to dispel misconceptions about VMMC. They collected contact information for those interested and provided information about when VMMC services would be offered.
The VMMC team worked with district health officers and health facility in-charges to make sure a sufficient number of people were trained and available to provide VMMC services during the identified peak periods. The team also worked with the health facilities to make sure that the necessary supplies and materials were available. The Ministry of Health accredited 31 new sites to provide VMMC services in the Lango Sub-region in addition to the 16 previously accredited sites.
As a result, RHITES-N, Lango doubled the number of young men receiving VMMC services between October (4,958) and November (10,380) and remained well above the target number in December (see graph).
The RHITES-N, Lango team will continue to target peak periods at the end of school terms and scale up school visits to mobilize potential clients. The team also plans to create a database to map those who have expressed interest in VMMC. This additional data source will help determine locations for future VMMC outreach activities.
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