Kaliua District, Tabora—As a traditional healer, Albert Cosmas uses experience with rituals and knowledge about herbal remedies he learned from his grandfather to heal people in his village of Ikombaboba.
One service he does not provide, however, is male circumcision, which is not a norm for the Nyamwezi people, the predominant tribe in his community.
Cosmas learned through public service announcements last spring that voluntary medical male circumcision (VMMC) services for HIV prevention would soon be available in his community. Although he understood and was impressed by the health benefits to him and his family, he declined the free service when it became available.
“It was the rumors,” Albert told Lusepo Kipenya, a peer educator with the AIDSFree project. Word had spread in the village that foreskins were being sent to Freemasons for conducting rituals. Cosmas and Lusepo had met at an improvised “TV hut” offered to the village to watch a soccer match.
“I was scared,” said Cosmas, 38, who lives in the village with his three wives and seven children. “All these villagers were afraid. They were saying, ‘Ah-haa, that’s why the services are free. The Freemason people are paying for it.’”
The impact on the VMMC services was immediate. “The Freemason rumor was very strong and stubborn,” said Lusepo. “Albert being an influential person, many followed his position and decided to stay away.”
Thus the program had to change its tactics. Using creative demand-generation approaches, the VMMC team went out into the village on a mission to dispel the rampant rumor. Lusepo and other peer promoters held meetings with community leaders focusing on educating boys and men about the benefits of VMMC, responding specifically to questions about the safety of the surgical procedure and how the foreskins are disposed of. Through this strategy, the tide began to turn on villagers’ understanding of male circumcision.
“I saw the whole procedure and the providers were very friendly...I will go beyond borders of my village to spread the good word on the services provided”
With support from the American people through the United States Agency for International Development as part of the U.S. President’s Emergency Plan for AIDS Relief, the AIDSFree program is working with the Tabora regional health administration to scale up high quality VMMC services in Kaliua and six other councils. With an HIV prevalence of 5.1% and a VMMC prevalence of 40%, Tabora is among 12 priority regions in Tanzania implementing the Ministry of Health and Social Welfare’s National Strategy for Scaling up VMMC Services for Male Circumcision for HIV Prevention. Research has shown that circumcision is an effective HIV prevention strategy, reducing a man’s risk of acquiring HIV by approximately 60 percent. When used in combination with other HIV prevention measures, including condoms, partner reduction, and abstinence, circumcision is an important addition to men’s HIV-prevention options.
Peer educator Lusepo spent several hours explaining the benefits of VMMC to Cosmas and others at the TV hut. Her efforts were successful. The next day Cosmas was among the clients who got circumcised at the Ikombaboba outreach site set up by providers from Limbula Dispensary, the main VMMC site serving seven neighboring villages. Before the procedure, Albert and fellow clients were provided with information about male circumcision, counseling and HIV testing services, screening for sexually transmitted infections (STIs), risk reduction counseling, and guidance on condom use.
“I saw the whole procedure and the providers were very friendly. They even offered to give me my foreskin if I wanted it. I said, ‘No, I trust you, just discard it like the rest,’” Cosmas said.
“The Freemason rumor was just that, a rumor,” he explained during his post-surgery visit to check on the progress of the circumcision wound. This visit occurs seven days after surgery and clients receive additional counseling including a reminder to abstain from sex for the next 42 days to ensure proper healing.
Cosmas’s bold step to be circumcised encouraged other men to make the right decision. In the same week Cosmas was circumcised, the flow of clients turned from a trickle of mostly boys from the nearby primary school and a few men, to a steady average of 20 to 28 adult men circumcised per day. Overall, the Ikombaboba outreach site and Limbula Dispensary were among high performing VMMC sites in the ongoing campaign, contributing 1,007 VMMCs of the 12,861 circumcisions done this year in Kaliua District.
To “heal” more people in his community, Cosmas started referring uncircumcised men or those with STIs to VMMC outreach services. He also volunteered to become a VMMC ambassador, accompanying peer promoters as they made their rounds in the village, helping to dispel rumors and misconceptions about VMMC and encouraging men and boys to take advantage of the free HIV prevention services.
“I will go beyond borders of my village to spread the good word on the services provided,” said a vividly transformed and satisfied Cosmas.