ZIO MWALE, Lusaka
FOR Nathan Cheelo, 31, male circumcision was a strange tradition only common in North-Western Province where non-medical circumcision was a culture. It’s something he never entertained in his mind, after all it
had no value as far as he was concerned.
His perception was to change in 2014 when the Ministry of Health launched a nationwide campaign for voluntary medical male circumcision (VMMC).
“Years back, talking about male circumcision in Chipata was a taboo, until in 2014 when the government declared the month of August as the month of voluntary medical male circumcision. That’s when my attitude started changing and I later decided to go for it,” Mr Cheelo said.
He recalls that during that time, a friend shared how circumcised males easily kept themselves clean and had a lower risk of contracting sexually transmitted infections (STIs).
Mr Cheelo made up his mind to go for VMMC when he learnt that circumcision can help prevent cervical cancer in women.
“I learnt that the human papilloma virus that causes cervical cancer is transmitted from a man to a woman. I also learnt that circumcision could help me keep myself clean and protect my wife from developing cervical cancer,” he says.
One day Mr Cheelo gathered some courage; he went to the clinic and asked to be circumcised. After the operation he drove back home on his own.
He recalls that the actual operation was not painful because he had been sedated before the procedure.
“Later on I felt some pain, but the pain is bearable. I was on leave when I went for circumcision so I had enough time to heal,” he shares.
He says the wound took a week to heal, but he had to abstain from sex for six weeks to allow for complete healing.
“I remember the doctor emphasising that I needed to stay away from sex until I was completely healed. I followed the instructions and now my wife is happier with my performance after I was circumcised,” he said.
Globally, male circumcision is a proven intervention that offers partial protection against sexually acquired HIV in men.
More than 154,000 men and youth in Southern, Central and Lusaka provinces have reduced their risk of contracting HIV, the virus that causes AIDS, through circumcision, courtesy of Society for Family Health (SFH).
Probably this could be attested by the high number of adolescents and older men that have undergone VMMC, as it is commonly referred to in the health circles.
SFH has been working with the Ministry of Health to spearhead male circumcision and the partnership has yielded positive results. SFH is a non-profit organisation affiliated to the Population Services International (PSI).
Recently, SFH with support from the Bill and Melinda Gates Foundation (BMGF) developed a new and innovative approach to creating demand for VMMC in the country through the introduction of the Human Centred Design (HCD).
The main purpose of HCD is to create innovative products, services and solutions through creative and collaborative practices. HCD helps organisations to have empathy and truly know their customers.
It is a practice with a philosophy of putting people first and involving them in every step of the design process. As such, it is expected to result in a more meaningful and valuable outcome for the client.
Since the inception of the project, SFH has contributed over 154,000 VMMCs to the national programme, making it one of the biggest partners involved in HIV prevention in Zambia.
Importantly, 70 percent of those circumcised are aged 15-29 years, which is the most impactful age group for epidemic control. The SFH-supported project is currently running in Southern, Central and Lusaka provinces.
No doubt, this has greatly contributed to reducing the spread of HIV and other STIs.
The World Health Organisation (WHO) says male medical circumcision provides men with at least up to 60 percent protection from HIV infection from infected female sexual partners.
It also decreases the risk of penile cancer and reduces the risk of infecting female sexual partners with the human papilloma, a virus that causes cancer of the cervix.
Meanwhile, SFH director of Bill and Melinda Gates Foundation VMMC Project, Albert Machinda, explains that his organisation has made tremendous progress in its efforts to prevent HIV and AIDS through VMMC by developing new innovations in demand creation such as HCD.
“Working with the Ministry of Health, we are contributing to an HIV-free Zambia. We targeted the most impactful age group and in a period of 30 months, over 70 percent of the 154,000 men circumcised are 15 to 29 years old,” he said
Dr Machinda said SFH shared good practices at international level on the effectiveness of HCD in conducting circumcisions.
“SFH is proud to have contributed to over 154,000 circumcisions from January 2015 to date across three provinces (Southern, Central and Lusaka). We have been invited to various international platforms to share information with the rest of the world on HCD,” he said.
By using innovative approaches and providing technical assistance to scale up VMMC in remote areas, SFH provides a platform where men and boys freely interact with counsellors to share information about VMMC.
SFH has also helped shape the clinical standards for quality VMMC in rural areas and on a national level. It has worked with the Ministry of Health to train 60 health workers to provide safe, high-quality procedures and developed protocols for quality assurance and improvement in VMMC programmes.
Dr Machinda said the Zambia National VMMC programme aims to circumcise at least 90 percent of HIV-negative men by 2020.
SFH communications and marketing director Linda Mafonko reaffirmed their commitment towards increasing access to quality VMMC services to prevent the spread of HIV in Zambia.
Ms Mafonko stated that the circumcisions being undertaken in health centres are medically proven, safe and effective procedures crucial for comprehensive approach to HIV prevention by correct and consistent condom use.
“Parents and women also have a role in increasing the uptake of VMMC by encouraging their partners, husbands, brothers and children to make the decision to be circumcised. The call to action starts in the home,” she said.
Ms Mafonko said the programme has also helped men and boys in the three provinces to access HIV testing, and information about sexual and reproductive health, while others have undergone other medical screening procedures.
“The myths that surround male circumcision have been a great challenge to the organisation. Some men do not even want to hear the word circumcision,” she explained. “I remember meeting a man who didn’t want to get circumcised because he heard that it is painful and that after circumcision, one should abstain from sex for months.”
Another common myth about MMC is that it makes men impotent or that it takes away the sexual pleasure, while other lies are that foreskins of circumcised men are sold for rituals.
Ms Mafonko dismissed all these stories as lies which discourage men from getting circumcised.
She stressed the point that all interested men should ensure that they are attended to by trained and competent providers in a sterile environment, using adequate pain management tools.