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- - - SERVICE PROVISION, MALE CIRCUMCISION IN KENYA

Thursday, 2nd of May 2013

• SERVICE PROVISION, MALE CIRCUMCISION IN KENYA

 

MMWR Morb Mortal Wkly Rep. 2012 Nov 30;61(47):957-61.

Progress in voluntary medical male circumcision service provision - Kenya, 2008-2011.

Centers for Disease Control and Prevention (CDC).

Abstract below; full text is at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6147a2.htm

In 2007, the national prevalence of HIV in Kenya was 7.1% among persons aged 15-64 years, with provincial prevalence rates ranging from 0.8% in North Eastern Province to 14.9% in Nyanza Province. Although an estimated 85.0% of males in Kenya are circumcised, nearly half of all uncircumcised men live in Nyanza Province, where circumcision prevalence is only 48.2%.

Based on the results of three randomized controlled trials in 2007 showing that medical male circumcision is effective in reducing HIV acquisition among men by approximately 60%, the World Health Organization and the Joint United Nations Programme on HIV/AIDS issued recommendations urging countries to offer male circumcision as an additional HIV prevention intervention. Kenya's Ministry of Health (MOH) prioritized the implementation of voluntary medical male circumcision (VMMC) services by targeting areas with low prevalence of male circumcision and high HIV prevalence. This report summarizes the progress of the VMMC scale-up in Kenya during 2008-2011.

By December 2011, a total of 340,958 males had been circumcised in 260 CDC-supported sites.* Among those VMMCs, 280,713 (82.3%) were conducted in Nyanza Province. A total of 273,115 (80.1%) VMMC clients were aged ≥15 years, and 49,162 clients (14.4%) were aged ≥25 years. VMMCs performed among clients aged ≥25 years increased from 5,938 (11.9%) in 2009 to 24,945 (14.9%) in 2011. Providing VMMC services to males aged ≥25 years remains a key challenge to reaching Kenya's national target of 80% VMMC coverage among uncircumcised males aged 15-49 years by the end of 2013.

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jmrH���m-alt:auto; line-height:normal'>During 2010-11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events.

 

CONCLUSION:

This work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches.