CHAPS

1. CHAPS Dr. Dirk Taljaard

2. Activities • Service delivery • Training • Technical Assistance • Start-up teams • Research

3. Service Delivery:Number of MC in OF since Jun ‘10

4. Service Delivery:Sites • Orange Farm (Linked Site) • Zola, Soweto (Integrated Site) • New site in Pretoria (Linked Site)

5. Training: • We have trained public and private sector • Training 4-5 Doctors/Nurses per week • 60 Doctors 120 Nurses in KZN (Not the full course) • Capacitated NGOs or assisted them (PHRU, SFH, MatCH)

6. Training:Courses • Clinical: • Doctors • Theory • Practicals • Nurses – Professional – • Blocking • Suturing • Nurses – Auxiliary • Surgery duties • Follow-up • PHC

7. Technical Assistance: • NDOH • Provinces: • Gauteng • Mpumalanga • Free State • Northern Cape • UNAIDS • WHO (MOVE Model) • Neighboring countries • Swaziland • Namibia

8. Start-up Teams: • Staff: • Dr, Nurse, Aux Nurse, Counsellor, Manager • Assistance: • Supplies • Processes and systems • Training • Mentoring • Time line • At most 1 month

9. Research: • Survey 2010 in Orange Farm • Demand creation studies • Other STI’s • HPV • HSV2 • MOVE Evaluation

10. What have we learnt?Part 1 • Minimum package of delivery crucial • Misunderstanding about MC very challenging • Language issues • Misinformation • Risk compensation • Risk to women • Excellent opportunity to engage young men about safe sex, HIV in general • VCT / HCT uptake much higher than in general population (VCT 35% HCT 70%) • Individual conversation important to individualise information and discuss 6 week abstinence

11. What have we learnt?Part 2 • Information delivery has to be flexible and dynamic • Test messaging outcomes • Obtain feedback from community • React to research findings • Huge interest from parents about their children • Information delivery has to be culturally sensitive • Photos and drawings • Without political backing and will MC will have limited impact -> National campaigns Uncircumcised Partially circumcised Circumcised

12. Self reported MC status • Men were asked “Are you circumcised?” • After the interview a physical examination was done to which they consented at the beginning of the interview • Physical examination was done by a male nurse • 45% of men who said they were circumcised had intact foreskin • Possible reasons: • Confusion between MC and Initiation • Confusion with words used, vernacular • Lack of knowledge on what MC is • How does HIV compare in these groups?

13. HIV (%) and circumcision status PRR=0.93 p=0.73 20.2% 18.8% ‘’Circumcised’’ with foreskin Uncircumcised

14. HIV (%) and circumcision status PRR=0.48p=0.002 20.2% 18.8% 9.5% ‘’Circumcised’’ without foreskin ‘’Circumcised’’ with foreskin Uncircumcised Thus, self reported MC status is a VERY unreliable indicator

15. Acknowledgements Bongiwe Klaas Tsietsi Mbuso Gaph Phatedi Bongani Mazibuku Agenda Gumbu Dr Shilaluke Dr Zulu Dr Gwala Dr Thabo Mashigo Dr Sean Doyle Dr Josephine Darko Frans Radebe Venessa Maseko Prof Bertran Auvert Dr Dino Rech Prof David Lewis Prof Adrian Puren Scott Billy Cynthia Nhlapo Prof Mohamed Haffejee Goliath Gumede Veerle Dermaux-Msimang Pascale Lissouba

16. Thank you! Dirk Taljaard dirk@chaps.org.za +27 82 454 6964