Background: For decades, Government had banned traditional male circumcision camps in Chiredzi Districts following mounting deaths due to poor safety. In 2009, the Shangani community partnered the Ministry of Health in delivering safe voluntary medical male circumcision that satisfies both the needs of tradition and HIV prevention. The chief''s interest in the integration centred on appeasing the increasing number of people who feared the traditional approach on safety grounds; and the promise of financial support and food that comes from the medical side. The medical side''s drive has been to reach intended targets for HIV prevention, with the circumcision being done in a safe environment. Publicising the Chiredzi VMMC results would also motivate other communities to pursue VMMC for HIV prevention.
Description: To maintain cultural fidelity, chiefs drive the circumcision agenda with the medical side coming in to support. Chiefs mobilize their people and the Ministry of Health mobilizes partners for transport, allowances for health workers, equipment, HIV counseling and testing and food. Chiredzi almost always faces a drought and people struggle with providing food for their children in camp. Non Shangani people including health workers who may participate in HIV counseling and testing are only involved at entry level, with the actual VMMC performed during camp by circumcised Shangani health workers. Partners mobilise non-Shangani people who may be willing to go through the circumcision rite, provide food and payment of mandatory token fees to the chief, which may preclude some participants from joining camp. In camp the men are also equipped with HIV prevention education, including debunking the myth that circumcision is a magic bullet against infection. Since 2009, 117,000 men have been circumcised in over 10 camps, some of which are from traditionally non-circumcising areas with no single death.
Lessons learned: The integration has allowed for win-win outcomes for tradition and HIV prevention. Dialogue on misconceptions about the real intentions of the medical side in targeting the Shanganis for VMMC has helped.
Conclusions/Next steps: Following interest and success, the programme is now being taken to districts where there are traditionally circumcising communities, while also attracting men from non-circumcising families and districts.