Male circumcision is a new HIV intervention strategy

Male Involvement within Marie Stopes International (MSI) – presentation and discussion

Engaging men in reproductive health continues to be a challenge for the global public health community. MSI have a global strategy to engage men in the following three areas: marketing of male contraceptives; addressing constraints on women’s FP (family planning) demand caused by male control, knowledge and attitudes; and marketing of male circumcision .

With regard to male contraceptives: vasectomy is the safest and most cost-effective LTPM (long-term and permanent method of contraception) but remains the least known and least utilised method throughout the world. MSI in Bangladesh has worked closely with the government of Bangladesh since 2006 to promote vasectomy as a safe, cheap, and viable permanent method of contraception and has to date provided over 150,000 vasectomies. The awareness-raising and behaviour change strategies included campaigns through community health fairs, the use of local health promoters, the use of media outlets and satisfied vasectomy clients as ambassadors for the service.

With regard to male barriers to women’s FP demands, MSI is collating a growing body of evidence to show how important a barrier this is – in some places even more so than access or affordability. A recent KAP (knowledge, attitude, and practice) survey in Sierra Leone had 30%^ of women cite their husband/partner’s disapproval as the main reason for not utilising family planning. Project ideas to reduce male barriers to FP include utilising traditional male social groups – such as village “grins” in Mali, or qat-chewing groups in Yemen – to increase awareness and acceptability within male decision-makers to FP and SRH issues.
Male circumcision is a new HIV intervention strategy. Traditional behavioural interventions for HIV prevention have been hampered by ideological differences and the inherent challenges in changing sexual behaviour on a mass scale. In December 2006 global MC (male circumcision) trials were completed which conclusively proved that MC reduced the risk of heterosexual HIV transmission by up to 60%.

Whilst the conclusive global studies all concentrated on heterosexual transmission, localised research in smaller-target group studies – for example, in Soweto, South Africa – have clearly suggested that circumcision is still protective for MSM populations and therefore MSM should not be excluded from circumcision programmes.

Male circumcision involves removing the foreskin from the head of the penis which reduces tearing during sex and also reduces the risk of HIV transmission due to the foreskin containing particular glands which are highly effective at transmitting HIV. Male circumcision is widely believed to be the first effective new biomedical prevention strategy for HIV.

There are of course challenges, not least of which is how to integrate MC into existing health infrastructures and also how to reach underserved and high risk groups. Further challenges include overcoming the cultural, financial, and religious barriers to MC and also overcoming the current lack of skilled providers for this service.

MSI piloted an MC project in 2007 in the Kisumu region of Kenya and has since expanded programmes to Malawi and Zambia. MSI is also a partner within a global MC project to expand MC services across Africa.

The greatest challenge to MSIC / Cambodia is how to access the funding for this intervention. Approximately 64% of the global HIV positive population (approximately 25.8 million people) reside in Africa and therefore this is where funding is concentrated. However, all male involvement strategies as outlined above will be considered by MSIC in the future implementation of this project and further technical assistance from the MSI global partnership is available.

Marie Stopes International Cambodia is happy to provide all kinds of reproductive health to esp. Gay and Lesbians.