A film by Lisa Russell, in collaboration with MCHIP, a PEPFAR funded program through USAID.
Speaking of support of Tohara, the local word for circumcision, Tanzania's president Kikwete references studies that show that voluntary medical male circumcision can decrease a heterosexual male's risk of acquiring HIV by up to sixty percent. Following WHO and UNAIDS recommendations, fourteen countries in Eastern and Southern Africa are scaling up their programs, potentially averting millions of new HIV infections.
Tanzania's Tohara Program hopes to reach individuals like Yohana. Yohana and his family live in Njombe which in 2012 split from Iringa and has been highly impacted by the HIV epidemic. When the country's male circumcision strategy began in 2010, Iringa had the highest HIV prevalence in the country at 15.7 percent compared to the national average of 5.7 percent. It also had one of the lowest male circumcision rates at 29 percent compared to 67 percent. The Ministry of Health with support from PEPFAR through USAID launched the voluntary medical male circumcision program in Iringa and began working with community leaders and the local media to attract clients. It wasn't an easy location to start this new initiative. Although there were challenges in bringing Tohara to this remote area of Tanzania, the accessibility and quality of the services attracted Yohana and his wife, Maria.
At age ten, Alpha reflects a growing group clients who are accessing services. Although the Tohara Program serves clients in different age groups in Iringa and Njombe, it is the adolescents age 10-19 and youth age 20-24 who are leading the way. They have decided they want to do it for HIV prevention reasons, for hygiene reasons, and they want to do it because it is considered modern. They know that eventually they may mix with people from circumcising regions and don't want to be the only uncircumcised boy. They know that women are now expecting their partners to be circumcised, but most importantly, they want to part of an AIDS free generation.
We are well prepared for the people and are quite sure that there will be a lot of people because today is actually Sunday and everyone will pass through churches and will go through political leaders and different village leaders, so today multiple people who are not easy, so I'm quite sure that will be having a lot of clients tomorrow, and I'm sure that we will hit the target.
Despite the enthusiasm for this HIV prevention intervention, clients are informed that it is not a magic bullet but more than ninety percent of other clients, Yohana and Alpha, consented for HIV testing before the surgery. They were also educated on other methods and informed that voluntary medical male circumcision only provides partial prevention from HIV infection. So as you can see, the surgical removal of the foreskin is just one component of what we actually need to call a combination approach of interventions.
Discharge instructions: male circumcision protective effects, not 100 percent.
Iringa and Njombe are on track to circumcise 341,000 clients by 2017. If the program manages to reach its goals, more than 20,000 HIV infections may be averted and 60 million U.S. dollars in treatment costs may be saved between 2013-2050.
Efforts to scale up services are not just occurring in Iringa and Njombe but throughout Tanzania. For the country's Tohara Program to be most successful, an estimated 2.1 million clients will need to be circumcised over the next five years. In order to meet this goal, Tanzania reorganized its health workforce more efficiently in order to serve more clients, more quickly. Nurses have played a key role in order to service voluntary medical male circumcision or VMMC providers. In Tanzania, since independence, we organized the shortage of trained medical personnel. The government of Tanzania had decided to do the kind of task-shifting, training of sub-cadre in all medical fields. So, the title of whether being a clinician or a nurse in these services, it ends there.
Tanzania has demonstrated its commitment to assisting and driving down the incidence of HIV/AIDS specifically as it affects voluntary medical male circumcision. They have decided that this is a way of reducing AIDS even further.
Despite the numerous obstacles that exist in scaling-up voluntary medical male circumcision such as cultural norms, difficult terrain, and fear of the unknown, the Tohara Program in Tanzania has shown that with strong leadership and commitment from the national government, the support of donors and implementers, and with the good-will of the people it is possible to scale up VMMC services and avert million of new HIV infections in Sub-Saharan Africa. Lives can be saved. A new generation can be AIDS free, and families like Yohana's are leading the way. And if it can be done in Tanzania, it can be done elsewhere too.