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World AIDS Day Spotlight: Supporting Uganda's Efforts to Combat HIV/AIDS through Male Circumcision
December 1 is World AIDS Day, providing an opportunity for people and organizations worldwide to unite in the fight against HIV/AIDS. URC has been supporting many Governments' efforts to combat the epidemic for over 30 years. Most recently, through the USAID Strengthening Uganda's Systems for Treating AIDS Nationally (SUSTAIN) and USAID Applying Science to Strengthen and Improve Systems (ASSIST) projects, we have been working in Uganda to expand coverage and uptake of voluntary medical male circumcision (VMMC), also known as safe male circumcision (SMC).
Uganda reduced its HIV prevalence rate from an average of 18% during the early 1990s to approximately 6.4% by 2004. Since then, however, the rate has risen steadily and now stands at 7.3%, posing a challenge for achieving Millennium Development Goal 6A (halting and reversing the spread of HIV/AIDS by 2015).
VMMC is a proven strategy for HIV prevention. The procedure involves surgically removing the foreskin, or the retractable fold of tissue that covers the head of the penis. The foreskin is highly susceptible to HIV infections. The World Health Organization (WHO) and the United Nations Program on HIV/AIDS recommend VMMC in countries, like Uganda, that have a high HIV prevalence and a low prevalence of male circumcision. Their reasoning includes:
- The procedure reduces the risk of female-to-male sexual transmission of HIV by approximately 60% and protects men not only from HIV but also other sexually transmitted infections, and
- Achieving and maintaining 80% VMMC coverage by 2025 would avert 3.4 million new HIV infections and reduce the number of people needing HIV treatment and care, saving the global community over $16 billion.
Despite this compelling evidence, Uganda has experienced slow VMMC uptake: Only 26% of males aged 15–49 are circumcised. Expanding VMMC coverage and uptake, in conjunction with other prevention methods, such as condom use and counseling and testing, could boost Uganda's fight against HIV/AIDS. URC is working with key stakeholders to move the VMMC agenda forward by strengthening hospital capacity and improving service delivery.
Strengthening Hospital Capacity
The USAID SUSTAIN Project has been supporting 12 regional referral hospitals and six general hospitals since April to scale up VMMC interventions in accordance with the Ministry of Health's policy and operational guidelines. The project aims to support the hospitals in annually circumcising up to 60,000 men. By September 2013, over 20,000 men had been circumcised through project-supported activities.
In recognition of World AIDS Day, SUSTAIN will work with supported hospitals in Gulu, Masaka, and Mubende districts to conduct VMMC camps from November 30–December 9 and raise awareness of HIV prevention through VMMC. Males ages 15 years and above and their spouses will be offered a package that includes counseling on HIV, VMMC, and sexual and reproductive health; screening for sexually transmitted infections; a pre-operative assessment; circumcision; and post-operative care and follow-up. SUSTAIN will provide camps with supplies, including disposable circumcision kits, and health workers with stipends. The project anticipates that each camp will circumcise about 100 clients each day, for a total of 3000 circumcisions. If achieved, over 150 new HIV infections may be averted.
Improving Service Delivery
The USAID ASSIST Project evaluated 30 PEPFAR-supported VMMC sites throughout Uganda in 2012. The evaluations, which were based on the WHO's Male Circumcision Quality Assessment Toolkit, highlighted numerous gaps in the sites' quality of VMMC services. ASSIST worked with key stakeholders, including the WHO, Ministry of Health, local district officials, and implementing partners funded by USAID, the Department of Defense, Walter Reed, and CDC, to develop assessment tools and improvement plans for the sites. It also conducted monthly coaching and learning sessions at the sites, allowing them to openly share best practices and lessons learned. By November 2013, the number of sites receiving a "Good" rating had increased significantly. Read the project's recent report to learn more.
URC's Long History Combating HIV/AIDS
URC has been combating the HIV/AIDS epidemic in Africa, Asia, Eastern Europe, and Latin and North America for over 30 years. We apply methods that are locally adapted and country led to improve health care systems. Working with local health care providers, community leaders, patient advocates, and government officials, we identify gaps in service delivery processes, then develop and scale up best practices to achieve sustainable improvements. Our programs are designed to advance the US Global Health Initiative's objective of creating an AIDS-free generation. Join the World AIDS Day conversation on Twitter @urcchs using #WAD2013!