Using Male Traditional Circumcision as Novel Approaches for HIV Prevention Messages:

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Using Male Traditional Circumcision as Novel
Approaches for HIV Prevention Messages

• Experiences Opportunities from
• the Southern Rift Valley of Kenya

Frederick K. Sawe, MBChB, MMED Deputy
Director Kenya Medical Research Institute/Walter
Reed Project HIV Program Kericho, Kenya
XVII International AIDS Conference August 5,
2008 Mexico City, Mexico
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Background Introduction

• Male circumcision is a valued cultural passage
  of rites for young men in the southern Rift
  Valley Province of Kenya where approximately 80
  of men report being circumcised, 75 of those by
  traditional circumcisers.1
• In this region, HIV prevalence rates range from
  6 to 11.2,3
• Annual circumcision ceremonies involve not only
  the young men but also their families, village
  members including elders and chiefs, and often
  community churches.

1. Shaffer et al. J Acquir Immune Defic Syndr
200745(4)371-379. 2. Foglia et al. Epidemiol.
Infect. 2008 May136(5)694-702. 3. National
AIDS and STI Control Programme, Ministry of
Health, Kenya. AIDS in Kenya. 7th ed.
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Background Introduction, cont.

• Traditional male circumcision ceremonies offer
  opportunities to provide HIV prevention, sexual
  and reproductive health (SRH), and gender
  messages education to young at risk males and
  their families and communities.
• During the 2007 circumcision season, we assessed
  the feasibility and acceptability to use the
  circumcision ceremony for integrating HIV
  prevention, SRH education, and gender education
  messages.

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Program Description

• First, local tribal Chiefs and Elders were
  engaged in discussions about the concept of
  bringing HIV/AIDS prevention messages in to
  circumcision ceremonies.
• Following strong support from the tribal Chiefs
  and Elders, teams went to villages and
  communities to further seek community interest
  and acceptance.
• Simultaneously, peer educators were trained on
  Ministry of Health HIV/AIDS prevention messages
  and the Men as Partners in Prevention
  curriculum.
• To achieve maximum coverage, simple snowball
  methods were used in training and delivery of
  prevention messages.

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Program Description, cont.

• simple snowball methods

training
prevention messages
Young Men
TOT
Peer Educators
Families
Peer Educators Community Members
Village And Community
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Initial Consultation With Council of Elders
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Results Coverage Training

• Geographic coverage
• 6 districts, 11 locations, 33 sub-locations, and
  172 villages participated
• Overall HIV prevention, SRH, and Men as
  Partners Training
• 340 family and community members were trained
• 222 (65) general caretakers
• 70 (21) parents
• 25 (7) Provincial Administrators
• 23 (7) religious leaders
• Of those, 305 (90) participated as volunteer
  peer educators

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Results

• HIV Prevention, SRH Education, Gender Education
  
• 45 circumcisers
• 58 with medical training e.g. nurse, clinical
  officer, medical officer
• 42 traditional
• 1,345 adolescent males
• 72 circumcised by persons with medical training
• 28 by traditional circumcisers
• Nearly all (97) circumcised were between 11 and
  15 years old
• Overall, 222 circumcision sites reached

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Program Strengths Challenges

• Strengths
• Early support by key village Chiefs and Elders
• KEMRI/WRP HIV Program with longstanding community
  partnerships (HIV prevention, care and treatment
  programs vaccine and therapeutics research)
• Program approach using simple methods and
  existing educational materials
• Challenges
• Interest and demand far exceeded initial
  expectations by overall numbers as well as
  interest by women (e.g. notable turnout of women
  interested in prevention training)
• Limited standardized, targeted prevention/educatio
  n materials
• This initiative was purely a program activity
  (not research and as such results presented are
  descriptive in nature)

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Discussion

• Areas of high circumcision uptake represent
  opportunities for HIV prevention, SRH education,
  and gender education.
• With community leadership engagement, HIV
  prevention activities can be successfully
  integrated into traditional circumcision
  ceremonies.
• A transition from traditional circumcision to a
  pseudo-traditional/medical circumcision appears
  to be ongoing in Kenyas southern Rift Valley
  Province.
• Medically trained clinicians are brought from
  health care facilities to the village and
  incorporated into circumcision ceremonies aiming
  to maintain tribal culture (but reflecting
  awareness of adverse outcomes associated with
  traditional circumcision).
• This transition presents additional opportunities
  for HIV prevention.

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Next Steps

• Scale up to meet community interests and demand
• Additional Families Matters Training
• Expand breadth and depth of data collection (e.g.
  type of health care providers, training received,
  suture vs. suture-less techniques, acceptability
  of standardized and accepted training for
  circumcisers)
• Follow-up of the young men (consolidate HIV
  prevention messages behavior change)?
• Consideration by villages leaders, MOH, and
  stakeholders of how best to support community
  move to pseudo-traditional/medical circumcision
  as prevention focus
• no missed opportunities for HIV
  prevention

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Acknowledgements

• Program Participants
• Village Chiefs and Elders
• Young men
• Families
• Communities and Village members
• Churches
• Sponsors
• Kenya Ministry of Health
• Kenya Medical Research Institute
• United States Military HIV Research Program
• Presidents Emergency Plan for AIDS Relief

• Kenya Ministry of Health
• Dr. Peter Cherotich
• Dr. John Odondi
• Kenya Medical Research Institute/Walter Reed
  Project HIV Program
• Mr. Wyckliffe Obwiri
• Mr. Warren Dalal
• Mr. Dixon Kigwenay
• Mr. Amos Kemei
• Mr. Charles Kilel
• Mr. William Sugut
• United States Military HIV Research Program
• Dr. Tiffany Hamm
• Dr. Nelson Michael
• Ms. Lisa Reilly
• Dr. Doug Shaffer

Asanteni na Karibuni Kericho, Kenya!