Author Delia Helie, originally posted October 9 2013, cross-posted December 19 2013:     Walking up to Carewell Clinic, I see scores of men and adolescent boys sitting outside under the sun, standing in small groups under tents, and purchasing fruit and sweets from the vendors who have set up outside the facility. All of these men and adolescents are here for the same reason - voluntary medical male circumcision (VMMC) for HIV prevention.

Inside the clinic, a line of men and adolescent boys are sitting quietly. I approach a well-dressed man in a sea of uniformed high school students. His name is Hlalele and he is just beginning the VMMC process. He has already gone through related group and individual counseling and is awaiting his screening, after which he will undergo the VMMC procedure.

The 24-year-old man grew up in Lesotho’s capital, Maseru, completed high school, and now works as a waiter at one of Lesotho’s large hotels, a job that he enjoys very much. However, on the advice of his older brother, he has taken the day off to visit Carewell Clinic for the free VMMC services offered through the Lesotho Ministry of Health (MOH) and the United States Agency for International Development (USAID)’s flagship Maternal and Child Health Integrated Program (MCHIP). Jhpiego implements MCHIP’s VMMC program with funding from PEPFAR.

"My brother came to Carewell and got circumcised. He said the doctors and nurses did a good job and it decreases the chances of getting HIV and it will be easier to keep myself clean. And my brother said it was a good service that wasn’t too painful," he says confidently.

Hlalele is one of hundreds of men and adolescent boys seeking VMMC services daily throughout Lesotho. In contrast to other countries - where rapid scale up of circumcision services has encountered problems due to lack of demand, cultural sensitivities, or insufficient integration with existing health systems - the MOH and MCHIP have implemented a step-by-step approach that is proving successful. In just 18 months, 33,000 men have been medically circumcised with continuous demand for services. Through strong leadership from the Lesotho MOH, the MCHIP VMMC program works within the existing health system, and respects cultural sensitivities regarding traditional rites of initiation to adulthood. This approach has been the key to the program's success. 

To meet the high demand for services, the MOH and MCHIP have opened 13 facilities, including at MOH, Christian Health Alliance for Lesotho (CHAL), and private facilities in eight of Lesotho’s 10 districts. All doctors, nurses and counselors providing VMMC participate in a two-week training on the WHO/UNAIDS/Jhpiego manual for male circumcision using local anaesthesia. Service provision is available two days a week (including Saturdays) in nine facilities, and daily in four high-volume sites.

With the success of the VMMC program, MCHIP has committed to ensuring high-quality, comprehensive services for all men and adolescent boys in Lesotho. These services include provision of HIV prevention messaging and condoms, linkages with care and treatment, and additional sexual and reproductive health education.

Moreover, VMMC uptake in Lesotho has the ability to change the course of the epidemic: modeling shows that for every five male circumcisions completed, one infection will be averted and millions of dollars are saved in care and treatment costs. The challenges now are keeping demand high and fully integrating VMMC into the national HIV prevention plan.

Before Hlalele went in for his screening, he proudly expressed his wish for all Basotho men to be circumcised: "It is temporary pain that will benefit all men. All men should do it!"

Click here to access this blog on the MCHIP website.
Image credit: Jhpiego
Delia Helie is a Peace Corps Volunteer attached to Jhpiego/Lesotho.