South Africa has opted to promote voluntary male medical circumcision (VMMC) as part of the package of HIV prevention services, although 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. This requires innovative strategies that target the barrier to uptake.
VMMC ambassadors play an important role in raising awareness about the procedure and its health benefits, and in encouraging the uptake of the procedure. JPS Africa interviewed one such ambassador, Itumeleng Tema, a Clinical Associate, to get his insights into the challenges and opportunities within VMMC.
Itumeleng lives in Nkangala, an area where traditional circumcision practices are part of the rites of passage to manhood. However, as with many traditional circumcision rituals across the country, these practices do not always result in a complete circumcision as well as often report a high death rate. “Right now it’s standing on 36.8% death rate for the area” notes Itumeleng. That’s why promoting VMMC is important for him. “We are able to save lives, or at least we can reduce the death rate.”
The high adherence to the traditional practices is problematic, but not insurmountable according to Itumeleng. People are critical of both the traditional rituals as well as the medical circumcision, but for different reasons. Their concern is that the former is too dangerous, but that the latter does not provide the same rite of passage or cultural emphasis.
This year JPS Africa partnered with traditional circumcision schools to take VMMC to the mountains with incredible results. “We had to convince them so that they would allow us, or give us chance to prove that we can do this without any deaths being reported, and we have done that. More that 800 initiates have been circumcised, and we have had no deaths reported in our hands.”
The health benefits of a full medical circumcision must be the centre of the drive to encourage people to opt for VMMC rather than a traditional circumcision, says Itumeleng. He elaborates saying that “with the medical circumcision patient, it is assured that he is sutured, and a sterile procedure is followed to ensure infection prevention. When you look at traditional circumcision, a sterile procedure is not followed.”
One of these benefits of VMMC is the reduced risk of HIV and STI acquisition. However, Itumeleng emphasizes that these benefits are only experienced using MMC, and not traditional circumcision. “When you cut traditionally, there is a 60% removal of the foreskin, and there are no guidelines, they just cut – as long as the foreskin is gone. What this means is that a man that is circumcised medically and have the full medical procedure , will have the benefit of reducing the chance of HIV infection by 60%, but a man that is circumcised traditionally will not have the same benefit.”
For Itumeleng it is important that the relationships with traditional leaders and the Department of Health are partnerships, ensuring that all parties benefit from shared information. “If enough education is given to our traditional leaders, when we, as partners of government, try to get involved, then they will understand what the benefits are and why we want to get involved.”
Itumeleng believes that he and JPS Africa will be able to maintain these relationships during the next coming years to ensure that zero deaths are reported in Nkangala.