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Zimbabwe’s Male Circumcision Program Partnerships and Collaboration for Success

Zimbabwe’s Male Circumcision Program Partnerships and Collaboration for Success. Presented by Dr Owen Mugurungi Director AIDS and TB Unit Ministry of Health and Child Welfare Zimbabwe. Epidemiological Context Zimbabwe. Population of 12 Million Adult HIV Prevalence of 15.6%

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Zimbabwe’s Male Circumcision Program Partnerships and Collaboration for Success

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  1. Zimbabwe’s Male Circumcision Program Partnerships and Collaboration for Success Presented by Dr Owen Mugurungi Director AIDS and TB Unit Ministry of Health and Child Welfare Zimbabwe

  2. Epidemiological Context Zimbabwe Population of 12 Million Adult HIV Prevalence of 15.6% Estimated 1.2 Million adults and children are living with HIV and AIDS (2007 estimates) Self-reported MC prevalence of 10% (2005-06 ZDHS) Zimbabwe’s major ethnic groups of Shona and Ndebele are traditionally non-circumcising communities MC performed in ethnic and religious minorities: Xhosa, VaRemba, Chewa, Tshangani and in Moslem communities HIV prevalence by age and sex 2005-06 ZDHS – CSO and Macro International

  3. Generally high acceptability for MC as HIV prevention intervention by both men and women Among women, concern about behavior disinhibition and infidelity Potential barriers to MC are costs, fear of pain and safety concerns Some circumcising communities prefer to continue MC in their traditional settings, others would accept the procedure to be done in clinical settings Zimbabwe MC Situation Analysis Acceptability

  4. MC in Zimbabwe–Milestones June 07--Consensus Meeting organized by MOHCW and NAC August 07--Mathematical modeling workshop August 08--MC situation analysis results disseminated during MC stakeholders meeting October 08--MC Stakeholders meeting, creation of steering committee and 3 technical working groups April 09--Training of national MC Trainers May 09--MC services initiated at first pilot site July 09--MC services initiated at 4 other pilot sites

  5. MC Strategy MC as part of comprehensive HIV prevention package, no cost to client MC program to strengthen health delivery system Multi-team approach, MOHCW taking the lead, technical support through NGOs, University of Zimbabwe, UN agencies, Traditional leaders Phased approach with learning phase, 5 MC pilot sites, including uniformed forces Cascade training through central and provincial training centers Core target group: men and adolescents aged 13–29 years Goal to circumcise 2,000 males by December 2009

  6. MC Service Delivery Developed national MC Training program Established one central level training site in Harare June/July--training of service providers from five pilot sites Forceps guided method adopted as standard method Sterilized pre-packed MC kits 400 men circumcised as of July 11, 2009 Demand for MC is high, 700 males volunteered to be circumcised when offered through HIV CT service in Harare

  7. Advocacy and Communications Phased approach in line with service delivery, “below the line” Advocacy: Media briefings, press conference, parliamentary committee on health, Cabinet, Chiefs, religious leaders Interpersonal communications and community mobilization in areas where MC is provided IEC materials with focus areas Information material for potential clients, posters at health care facilities Patients information material Flipcharts for CT and MC providers

  8. Lessons Learnt Strong Government support for MC Good collaboration and partnerships between Government, NGOs and communities are key to success Committed, technically strong, multi-sectoral team in the MC steering committee and three technical working groups Originally strong health delivery system Well-established, decentralized strong coordination structures High latent demand for MC in the population Potential donor interest in funding MC scale-up

  9. Next steps Review of the pilot phase Development of 5-year MC strategy 2010-2014 Mobilization of resources for MC rollout Establishment of provincial training centers Nationwide facility assessments in preparation for MC services scale-up Nationwide rollout of Male Circumcision services by 2010

  10. Acknowledgements All the Zimbabwean men who have benefited from the MC program National AIDS Council ZNFPC UNAIDS/WHO UNFPA USAID DFID University of Zimbabwe PSI/Zimbabwe SAFAIDS Traditional Circumcisers of Zimbabwe Zimbabwean Community Leaders Population Services Zimbabwe Ministry of Health and Child Welfare

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