1. SCALING UP MALE CIRCUMCISION PROGRAMMES IN THE EASTERN AND SOUTHERN AFRICA REGION TANZANIA 8 TH TO 10 TH JUNE 2010 Malawi Presentation

2. Introduction & Background  Malawi has 13.1 million people  Adult HIV prevalence 12% (MDHS, 2004).  Among the sexually active population, the HIV prevalence is higher among females (13%) than males (10%)  Approximately 1 million people living with HIV  Approximately 85,000 new infections annually

3. MC Background  MC is Concentrated in Southern Malawi mostly among the Yao(lakeshore area), mang’anja & Lhomwe with strong Muslim influence.  Not widely practiced in most parts of the country.  Religion and culture are main determinants of MC in Malawi.  The coming of Christianity and colonial administration influenced some Yao to stop MC. Viewed as genital mutilation.

4. MC Current Situation  National MC Prevalence 21%(Respondent)-2004 Malawi DHS  5% in the Northern region  12.2% Central Regions  33% in Southern region  MC situation analysis indicated 26.7% (Respondent) WHO Standard definition 23.0 % Prevalence-(MC SITAN)  National HIV prevalence 12.1% with large regional variations (2007 Sentinel Surveillance)  8.1% Northern, Centre 10.7%, & 17.6% South.

5. MC Prevalence by Region

6. Stratified Analysis Ethnic GroupHIV among circumcised HIV among uncircumcised Yao9.513.4 Hlomwe13.816.4 Malawi DHS 2004

7. Accomplishment  National MC consultative meeting held 2007.  National Task Force in place  MOH Chairing  NAC secretariat  MC included in the HIV Prevention strategy  MC activities in the HIV Prevention Strategy operational Plan  Situation analysis done and completed  Report accepted and adopted by MC subgroup

8. Policy Environment  MC is recognized in the newly adopted 2009-2013 National HIV Prevention Strategy.  2009 Operation Plan indicates development of an MC Policy and service delivery guidelines(Standard Operating Procedures) & communication strategy.  National MC taskforce formed, chaired by Ministry of Health and NAC secretariat.  Consultations with key social groups ongoing.  Situation analysis on MC done, report finalized & adopted.

9. Challenges  MC Cultural & religious link very significant.  MC driven by experts and elders  Low involvement of young people in MC  Notable opposition to MC in the past.  Traditional leaders and Christian community  Cross sectional data presents a complicated picture ( High HIV prevalence among the circumcising community)

10. Opportunities  Established link/referral system in the circumcising area between TMC & Hospitals for surgery.  MOH partnering with NGOs(BLM, PSI & Jhpiego)  BLM has 31 MC active sites  Culturally delinked (VMMC)  MC offered to drop in clients in public sector.  Rich ground for donor support & media readiness  Involvement of Academic Institutions in MC research.  Minimum pre-requisites in both rural and urban facilities to offer MC. (MC SITAN 2010)

11. Next steps/ Areas that need support  Development of standard operating procedures(Guidelines)  Development of Communication Strategy  Development of operational plan on VMMC  Capacity building  Conducting Costing and needs assessment in the public sector.