Creating demand for safe male circumcision in rural communities in Uganda

Health Service Workers help set up a tent clinic at one of STAR-EC's 'circumcision camps'

“Doctor, Doctor! Thank you very much for treating us,” a smiling Roger Masambala exclaims, greeting the health worker who has made his way out to Roger’s fishing village in on Lolwe Island, Namayingo District, Uganda. Six months earlier, Roger, a 27-year-old fisherman, became one of the thousands of men in the region to receive safe medical circumcision provided by the Safe Male Circumcision (SMC) initiative set forth by the JSI-implemented Strengthening TB and HIV&AIDS Responses in East Central Uganda (STAR-EC) project, funded by USAID. “I was circumcised in March 2011, when you people came to Golofo,” he explains, referring to the SMC procedure he received at one of the mobile ‘circumcision camps’(temporary surgical clinics)created by STAR-EC to serve rural, East Central Ugandan districts.

Patients receive safe circumcision at a STAR-EC Safe Male Circumcision ‘camp in Golofo, Uganda
The camps were part of a comprehensive strategy designed by JSI to promote awareness of and access to SMC, a procedure known to decrease the risk of HIV and other STI transmissions. Partnering with the Ministry of Health, the Rakai Health Services Project (RHSP), and the Makarere University Walter Reid Project (MUWRP), JSI carried out a detailed assessment of the needs of the regional population and the readiness of existing medical clinics to facilitate an increased number of SMC procedures. Prior to the intervention, under-resourced clinics placed SMCs as a relatively low priority, channeling their efforts into other, more immediate health needs.

Based on their analysis, STAR-EC rolled out SMC activities, starting with the dissemination of 36,000 informational SMC leaflets, ninety-six flip charts, and 320 health workers booklets, all provided by the Health Communications Partnership (HCP) project, to create demand for the service and educate the local population on the benefits of SMC. JSI also reached out to district leaders, Ministry of Health Officials,CSO and religious leaders to increase awareness of SMC services as a HIV prevention strategy. STAR-EC trained 90 Ugandan health workers to provide SMC services and procured the necessary equipment and supplies for those clinics which were deemed unready to accommodate the increased demand for SMC procedures. STAR-EC instituted weekly SMC clinic days at fifteen health facilities and lent support to 130 SMC-related outreaches and three SMC ‘camps’, including the one in Golofo, where Roger was treated.

In all, 14,347 men and boys received SMCs during STAR-EC’s second and third year of operation, an increase of 13,544 procedures over the previous year, and more than triple the project’s goal of 4,350 SMC procedures. Nearly half of those men and boys were served through outreach efforts or at the SMC camps. The static clinic days and circumcision camps provided the additional benefit of offering HIV tests to men receiving SMCs, thus increasing the number of people in the region receiving HIV Testing and Counseling (HTC) services. Out of all of the recipients of SMC procedures, only 0.8% reported adverse post-surgery symptoms, like pain and infection, and all of the reported symptoms were managed to complete resolution.

Now, there is increased awareness among local families about the benefits of SMCs and an increased demand for the services. By receiving SMCs, patients like Roger experienced improvements in their health and hygiene, awareness of their sero-status, and increased knowledge of how to further protect their health and the health of their families. “[Now] I am smart and clean,” Roger says. “I used to fear whenever I went to my wife, but all that is history now…Honestly, if I were a minister or was in Government, I would make it a law for everyone to circumcise.”