Health ministry reviews safe male circumcision strategy
Zolani Kraai | Tuesday August 29, 2023 17:48
An engaged consultant is already at work on implementing the scope of tasks that will eventually lead to consultations on the analysis of the current strategy and its findings. Globally, it’s known that circumcising 80% of HIV-negative sexually active men could reduce new infections by 60%, highlighting the cost-effective nature of safe male circumcision. The Monitor learned the information underscores the relevance of VMMC. The procedure is also offered to HIV-positive men for medical reasons, as research suggests it reduces genital ulcer disease amongst them. Nevertheless, VMMC demand creation has remained a challenge in Botswana since the programme’s inception in 2009, targeting HIV-negative men aged 0–49 years.
A significant proportion of those circumcised were schoolgoing children aged 10 and above. However, adverse events in this group led to their exclusion, prompting a shift in focus to the 15–29 age group, following guidance from the World Health Organisation (WHO), the Centre for Disease Control (CDC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Additionally, Botswana has taken up an early infant circumcision (EIMC) initiative that targets babies within the first 60 days of life.
However, the Ministry of Health and Wellness (MoHW) has labelled this endeavour as unsuccessful due to procurement issues with the necessary device. They've also noted that in the initial stages of the programme, doctors primarily carried out the circumcision. Responding to this, Dr Christopher Nyanga, the chief public relations officer at MoHW, explained that task sharing has led to more nurses conducting the surgical procedure. This has been made possible through financial support not only from the government but also from entities like the Global Fund, the US President’s Emergency Plan for AIDS Relief (PEPFAR-CDC), and the African Comprehensive Partnership on HIV/AIDS (ACHAP), amongst others. Nyanga further highlighted the challenges faced by the Voluntary Medical Male Circumcision (VMMC) programme due to the impact of the COVID-19 pandemic, particularly in generating demand.
He underscored the success of involving nurses in performing surgical procedures, a move that has significantly improved accessibility. Furthermore, various facilities in districts have been equipped to provide circumcision as part of their regular services. This means that clients can receive the procedure conveniently when they visit these facilities. Nyanga also mentioned that the programme has transitioned from using disposable kits to reusable ones to reduce expenses. In the past, circumcision was performed using devices like PrePex. “In the financial year 2019–2020, there were 18,171 circumcisions done. In the COVID-19 year 2020–2021, there were only 3,471 circumcisions performed countrywide and even the subsequent year only had 4,809. BAIS V of 2021 has just shown that the circumcision prevalence in the country is only at 48.4%,” he said. Discussing the progress and achievements of the VMMC initiative in Botswana, Nyanga revealed the scope of their efforts. "The first strategy (2009–2016) aimed to reach 385,000 negative males aged 0–49 years.
In the subsequent 2017 to 2022 strategy, we targeted 298,180 males within the same age group," he stated. By March 2023, the second strategy had resulted in a cumulative count of 285,179 males being circumcised across the country. Amongst them, 6,021 were infants. According to the fifth Botswana AIDS Impact Survey (BAIS V) of 2021, national circumcision prevalence stands at 48.4%, revealing the need to make significant progress towards the 80% target. Unfortunately, infant circumcision faced challenges in 2016 due to a shortage of circumcision devices available in the market. However, Nyanga assured that changes are underway. The circumcision programme is transitioning into an integrated approach, expanding its services for men. In this new model, men will undergo HIV testing, receive Pre-Exposure Prophylaxis (PrEP) if their status is negative, and be linked to Anti-retroviral (ARV) treatment if positive.
Additionally, those with Sexually Transmitted Infections (STI) and other health concerns will be appropriately referred. Nyanga highlighted the significant achievements of task sharing with nurses who now perform surgical procedures. This expansion has increased accessibility, as many district facilities have been equipped as static sites for circumcision. This allows clients to be circumcised during their visits or walk-ins. The programme's approach has also evolved to reduce costs, shifting from disposable kits to reusable ones. In the past, circumcision devices like PrePex were utilised for the procedure.