1. Dr. Dirk Taljaard

2. Activities Service delivery Training Technical Assistance Start-up teams Research

3. Service Delivery: Number of MC in OF since Jun ‘10

4. Orange Farm (Linked Site) Zola, Soweto (Integrated Site) New site in Pretoria (Linked Site) Service Delivery: Sites

5. We have trained public and private sector Training 4-5 Doctors/Nurses per week 60 Doctors 120 Nurses in KZN (Not the full course) Capacitated NGOs or assisted them (PHRU, SFH, MatCH) Training:

6. Clinical: Doctors Theory Practicals Nurses – Professional – Blocking Suturing Nurses – Auxiliary Surgery duties Follow-up PHC Training: Courses

7. NDOH Provinces: Gauteng Mpumalanga Free State Northern Cape UNAIDS WHO (MOVE Model) Neighboring countries Swaziland Namibia Technical Assistance:

8. Staff: Dr, Nurse, Aux Nurse, Counsellor, Manager Assistance: Supplies Processes and systems Training Mentoring Time line At most 1 month Start-up Teams:

9. Survey 2010 in Orange Farm Demand creation studies Other STI’s HPV HSV2 MOVE Evaluation Research:

10. What have we learnt? Part 1 Minimum package of delivery crucial Misunderstanding about MC very challenging Language issues Misinformation Risk compensation Risk to women Excellent opportunity to engage young men about safe sex, HIV in general VCT / HCT uptake much higher than in general population (VCT 35% HCT 70%) Individual conversation important to individualise information and discuss 6 week abstinence

11. What have we learnt? Part 2 Information delivery has to be flexible and dynamic Test messaging outcomes Obtain feedback from community React to research findings Huge interest from parents about their children Information delivery has to be culturally sensitive Photos and drawings Without political backing and will MC will have limited impact -> National campaigns UncircumcisedPartially circumcisedCircumcised

12. Self reported MC status Men were asked “Are you circumcised?” After the interview a physical examination was done to which they consented at the beginning of the interview Physical examination was done by a male nurse 45% of men who said they were circumcised had intact foreskin Possible reasons: Confusion between MC and Initiation Confusion with words used, vernacular Lack of knowledge on what MC is How does HIV compare in these groups?

13. HIV (%) and circumcision status 13 ‘’Circumcised’’ with foreskin Uncircumcised PRR=0.93 p=0.73 18.8% 20.2%

14. HIV (%) and circumcision status 14 ‘’Circumcised’’ with foreskin Uncircumcised PRR=0.48 p=0.002 18.8% 20.2% 9.5% ‘’Circumcised’’ without foreskin Thus, self reported MC status is a VERY unreliable indicator

15. Prof Bertran Auvert Dr Dino Rech Prof David Lewis Prof Adrian Puren Scott Billy Cynthia Nhlapo Prof Mohamed Haffejee Goliath Gumede Veerle Dermaux-Msimang Pascale Lissouba Acknowledgements Bongiwe Klaas Tsietsi Mbuso Gaph Phatedi Bongani Mazibuku Agenda Gumbu Dr Shilaluke Dr Zulu Dr Gwala Dr Thabo Mashigo Dr Sean Doyle Dr Josephine Darko Frans Radebe Venessa Maseko

16. Dirk Taljaard dirk@dirk@chaps.org.za +27 82 454 6964