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In Tanzania, over one million people have received HIV testing and counseling, and over 165,000 men have undergone medical circumcision to lower their chances of contracting HIV, thanks to IntraHealth International’s collaboration with the government of Tanzania.
With a national prevalence rate of 5.1%, Tanzania is home to some 1.4 million people living with HIV. That’s why the country’s government has teamed up with IntraHealth and our local partners to make sure more Tanzanians know their HIV statuses and have access to treatment and prevention services, including medical male circumcision.
Since 2006, more than one million individuals have opted for HIV testing provided through IntraHealth’s Tanzania HIV Prevention Project and its predecessor, the Tanzania Provider-Initiated Testing and Counseling Project. The project then refers those who are identified as HIV-positive to local care and treatment centers.
Medical male circumcision can reduce the transmission of HIV through heterosexual sex by up to 60% in men, and the government of Tanzania has made scaling up effective, high-quality circumcision services a priority as part of its strategy to combat the epidemic.
But getting men—particularly those for whom it is not already a cultural norm—to line up for circumcision is no easy feat.
Through a combination of education, service expansion, and creative outreach, the project has succeeded in removing obstacles to services and raising demand. By educating communities on the protective benefits of circumcision, training more health care providers to safely perform the procedure, and using a combination of mobile campaigns and static clinics, IntraHealth has reached more than 165,000 men and boys since November 2010.
Despite early success in drawing men and boys to circumcision services, the project struggled to reach its target audience of men over the age of 20—men who are generally more sexually active and thus face greater risk of infection.
That’s when IntraHealth teamed up with a local partner, the Tanzania Youth Alliance, to try something new. Enlisting the power of some 6,000 popular opinion leaders—a network of religious leaders and magnetic personalities who have all been nominated as role models by their peers—and by drawing on the ubiquity of mobile phones in Tanzania, IntraHealth and the Tanzania Youth Alliance launched an intensive social mobilization effort to reach men over the age of 20.
It works like this: Popular opinion leaders and clients who have already been circumcised reach out to men through mobile public address systems, mobile cinema campaigns, and community events to share their stories and information about the services. Men who are interested in the procedure can sign up for an SMS service, through which they will receive 25 tailored text messages in Swahili over the course of six weeks. The messages include details about upcoming mobile clinics, appointment reminders, and reproductive and sexual health information. They also remind potential clients that the services are free and that men over the age of 20 will receive priority appointments.
And it’s made a difference. Before the intervention, only 7.1% of clients who opted for male circumcision were over 20 years old. During the first three months of the intervention (January through March 2013), that number climbed to 28%. And between April and June 2013, it rose to 32%. Of all the clients who opted for circumcision during April, May, and June, 29% said they were referred by the Tanzania Youth Alliance’s SMS campaign.
The project team believes that not only are more men learning about their services, but that having set appointment times and messages showing clients their priority statuses have brought more clients in.
During a review by the US government in September 2013, members of the assessment team praised the project’s successes and the hard work of the local male circumcision providers. They also suggested that Tanzania consider the Shinyanga region clinic sites to be models for the rest of the country.