Swaziland has the highest rates of HIV, with 31% prevalence among sexually active adults. As a result there is an urgent need to scale up HIV prevention response in Swaziland using a combination approach. The objective of the Male Circumcision (MC) unit is to increase the uptake of voluntary medical male circumcision (VMMC) among all eligible males in Swaziland. VMMC is a critical pillar of Swaziland’s HIV response. VMMC is considered to be a safe and effective method which contributes towards reduction of new infections by as much as 30%.
In 2008, Swaziland started the scaling up of male circumcision (MC) as a HIV prevention strategy, . A policy on safe voluntary male circumcision for HIV prevention was developed in 2009 and a Communication Strategy in 2011. The MC services have now been integrated into a majority of public hospitals and health centres, NGO supported fixed sites, outreaches, mobile services and targeted campaigns. Intensified advocacy for MC has resulted in improved MC uptake as evidenced by the high uptake of the service by young men during school holidays. The rate of MC among those aged 15-49 has more than doubled from 7% in 2007 to 19% in 2010. As part of MC operationalization, systems have been strengthened including an adverse event management system.
The main focus of MC in the country is VMMC which refers to adolescent and adult male circumcision services. However, the ministry separates the terms to accommodate infant circumcision, known as early infant male circumcision (EIMC). EIMC is used to describe circumcision for healthy baby boys, which takes place during the first 60 days of life.
The Kingdom of Swaziland is one of the first countries to use this recently developed model for male circumcision strategic and operational planning. The model enables male circumcision coverage targets to be set for specific age groups at the national, regional and Inkhundla level. This results in better targeting for male circumcision strategies. According to this model, circumcision of 353,000 adolescents and adults and 169,000 infants would avert 56,000 HIV infections and provide cost savings of US$370 million by 2035. Read More
Benefits of MC
In 2005 and 2006, randomized controlled trials in three African countries showed that VMMC can reduce men’s risk of acquiring HIV infection from heterosexual intercourse by as much as 60%. VMMC also benefits women over time by decreasing the number of HIV infected men in the population, thereby reducing the probability that women encounter HIV infected sexual partners. Furthermore, VMMC reduces the risk of acquiring several Sexually Transmitted Infections (STIs), including Human Papilloma Virus (HPV) infection and cervical cancer among women. Recognizing that VMMC is a high impact public health intervention the Ministry of Health adopted VMMC as another strategy to stem the tide of new HIV infections.
Achievements of MC
- By end of 2013, over 54,000 males have been circumcised, including 4,000 infants, out of the approximated 250,000 eligible males, representing 21.6% MC prevalence.
- DMPPT 2.0 modelling for results for Swaziland has been completed by Futures Institute with support from PEPFAR.
- National geographical mapping of circumcised men by Inkhundla and by age from 2008-2013 has been conducted.
- There is active involvement of Ministry of Education and Training in the Back To School campaign.
- Conducted a KAP study on barriers for uptake of EIMC and identification of programme barriers through operational research-ethnographic survey.
- Quality Assurance for VMMC is being implemented within SNAP and through the Quality Management Programme.
- There is strong partnership between GKOS and USG with strong commitment from VMMC implementing partners.
- Appointment of Senior Programme Officer to Lead VMMC programme within MoH-SNAP.