First in His Village, 100,000th in the Shinyanga Region

The other village officials in the room thought Damasi Ngereja was joking when he volunteered to be first in line for circumcision in the Tanzanian village of Lunguya. But Damasi wasn’t laughing. If anything could help convince his friends and neighbors that medical male circumcision was worth thinking about, it was seeing the village executive officer—an elected official—go through it first.

Historically, Lunguya men haven’t practiced male circumcision, be it medical or ritual. Less than a third of men in the Shinyanga region—where Lunguya is situated—are circumcised, a much lower percentage than the national average of 72%. Shinyanga also has a higher HIV prevalence rate than the rest of the country—7.4% of 15-49 year olds are HIV-positive, compared to the national rate of 5.1%.

That’s no coincidence. Low rates of male circumcision often go hand-in-hand with high rates of HIV infection. Circumcision removes the foreskin tissue that is most vulnerable to HIV transmission. Men who are uncircumcised are not only more likely to contract the virus, but are more likely to pass it on to their partners.

That’s why a team made up of Shinyanga health workers and staff from the Tanzania Youth Alliance (TAYOA) and nonprofit IntraHealth International had arrived in Lunguya to talk about the procedure’s virtues. Knowing that plenty of locals would be skeptical about circumcision, Damasi and his colleagues were meeting with the team to talk about ways to inform the community and encourage men to take advantage of the services, which could lower their HIV risks. That’s when Damasi raised his hand.

“I will be first to be circumcised in Lunguya village,” he said.

Since 2010, IntraHealth has been working with health management teams in the Shinyanga Region to offer medical circumcision services to men, both in clinics and through outreach campaigns. Clients that live far away from health facilities can sign up to receive text messages about outreach services coming their way.

Damasi signed up for the texts. And it wasn’t long before he received a message about a campaign on its way to Lunguya. So Damasi talked to his neighbors about it, encouraged them to bring their friends, and even helped organize a social cinema night (complete with a bit of male circumcision education) out of TAYOA’s van. The day the campaign started at the local Lunguya Health Centre, Damasi was among the first to show up.

He sat with other clients for group education before an individual counseling session and a physical exam. Then it was time.

After the procedure, clinic staff gave Damasi a bottle of water, some painkillers, and tips on postoperative care. And before he left to recover at home, they made a follow-up appointment for him to come back in 48 hours, to make sure all was well with the healing process.

In just a few days, Damasi was walking to work again. And a few weeks later, he took his three sons to be circumcised as well. Thanks to Damasi, some 2,200 men and boys were circumcised over the course of three weeks at the Lunguya Health Centre.

“Many older men have come to ask me about the procedure and experience,” Damasi says. “I have escorted a church leader, a counselor, and teachers in getting [circumcision] services. The community needs this service and thank you very much for the [male circumcision] program and providers. Please come again after the rainy season, as there are still more people in need of the services and they are busy with farming activities now.”

Not only was Damasi one of the first men in Lunguya village to be circumcised—he was also the landmark 100,000th client in the Shinyanga Region. Today, over 125,000 men in the region have opted for the procedure, thanks to the efforts of the Shinyanga regional health management team and IntraHealth. Project staff hope to raise that number to 135,000 by September 2013.

This work was conducted by IntraHealth’s Tanzania HIV Prevention Project, which is funded by the President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.

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