Voluntary Medical Male Circumcision (VMMC) has been introduced in many countries as one of many efforts to reduce the transmission of and susceptibility to, HIV. Since 2007 the World Health Organisation and UNAIDS have recommended VMMC as one of the central components of HIV prevention, particularly in countries where few men are circumcised.
Although many African countries including South Africa, Namibia, and Kenya promote VMMC as part of the package of HIV prevention services, a recent UN report suggests that there has been a decline in the number of VMMC procedures performed since 2014. In order to meet the target of 80 percent coverage in relation to reducing new infections and the spread of HIV, the number of circumcisions needs to double. Using innovative and affordable technologies such as PrePex may assist in driving the scale of VMMC, and community sensitive approaches will be key to promoting the practice.
Speculation around the causes for the decline in circumcision numbers brings up two arguments – one personal, and one political. The latter involves the need for dedicated funding for HIV prevention, hence political will to drive the process. The former is far more complex. Personal reasons for not undergoing the practice are likely to be linked to social norms around circumcision and the normative expectations of the men in these communities. What this means is – if men think that other men and women whose opinions they value think that they should be circumcised, they are more likely to do so.
Enter the value of VMMC ambassadors as agents of change. As trusted members of the communities where VMMC would be most effective as an HIV prevention technique, they have the potential to influence both men and women in the community, hence breaking down the stigma around circumcision. Two examples from Namibia and South Africa provide evidence of the success of these initiatives.
In Namibia, the Dogg, popular music artist publicised his decision to ‘get the smart cut’ at an event primarily attended by Namibian youth. By working at events like this, as well as campaigning at schools and tertiary organisations, the Dogg has spread the message of the benefits of VMMC to the groups that need it most – the majority of HIV in Namibia continues to be spread via unprotected sex, and people under 30 are most at risk.
Ambassadors like Khanyisa Dunjwa in South Africa have made significant inroads in communities in South Africa’s Eastern Cape, ensuring that men and boys are informed about their options. Through engaging multiple stakeholders including local leaders, government officials, and the community on the need to educate adolescent boys about their options, the need for safety during the traditional circumcision process, and strategies to protect themselves from HIV. Interestingly, Dunjwa has also included women who are often excluded from the conversation around circumcision. In this way, she ensures that mothers are aware of how to support their sons.
Complex problems require creative strategies that can work with people at a personal level. In the Kenyan example, peer education and community engagement worked well to de-stigmatise not only the practice but dialogue around it. Public figures who promote the practice, as in the Namibian example, could also promote the acceptability of VMMC, driving people towards the practice rather than away from it.
