1. The Male Circumcision Project
Goal and Rationale

2. Project goal
Decrease HIV prevalence by increasing the coverage of MC as part of a comprehensive HIV prevention strategy

3. How will we do this? Increase access to safe adult MC services;
Increase informed demand for safe MC services;
Ensure safer sexual behaviors among MC clients and partners of clients;
Improve the cost effectiveness, quality and efficiency of MC services; and,
Establish an enabling environment for the increased involvement of host country governments, other donors and organizations in expanding MC services and increasing MC prevalence.
Obviously, MC counselors will play a large role in the success of this project. The contributions of MC counselors will be felt most in four of the five objectives of this project.

4. Why male circumcision?

5. Simple comparison provides first evidence of MC – HIV link
HIV prevalence
MC prevalence
When scientists compared HIV prevalence to the prevalence of male circumcision in Africa, they found that the two appeared to be inversely related—meaning that places with a higher prevalence of male circumcision seemed to have a lower HIV prevalence. Notice how the lightest areas of red in the HIV prevalence figure (on the left) seem to correspond roughly to the darkest areas of red in the MC prevalence figure (on the right). You see the inverse relationship most clearly in southern Africa—notice how Swaziland and Zimbabwe are red in the HIV prevalence figure, indicating a high HIV prevalence, but are yellow in the MC prevalence figure, indicating low MC prevalence.

6. Better research shows impact of MC on HIV prevalence
Conducted research to assess this theory:
South Africa—semi-urban
Kenya—urban
Uganda—rural
After two years, found that:
Circumcised men → 2.6% HIV prevalence
Uncircumcised men → 7.4% HIV prevalence
Circumcised men less likely to acquire HIV
As a result of the comparisons you saw in the previous slide, scientists designed studies to investigate further MC vs. HIV prevalence. They launched three random-controlled trails, which are considered “gold standard” studies since they help us to clearly identify relationships. In this case, these studies recruited two groups of uncircumcised men. One group was later circumcised and both groups were followed over a period of time to see if they experienced different incidences of new HIV infections. Scientists found that the group of circumcised men had a lower incidence of HIV infection. The studies also identified other benefits of male circumcision, which we will discuss later today. We will also discuss how MC might reduce the risk of HIV infection.

7. How do we fit into the project?

8. Counselors are key to this project
Help men understand benefits and risks of MC
Help men plan for life after MC
Respond to fears of men accessing MC
Support men to make good decisions
Ensure quality services
MC counselors play an important role in this project. Our research shows that many men are interested in MC but want to know more about the procedure and how it will impact their lives. The job of counselors is to help them understand the benefits and risks of MC so that they can make an informed decision about having the procedure. Also, counselors help men think about and plan for the impact of MC on their life. We need to make sure that men understand that MC is not 100% protection from HIV so they need to take measures to protect themselves, even after the procedure. Your role is to help them think through the actions they will take to protect themselves. Many men are afraid to MC and your job is to understand and help allay those fears. Once a man makes a decision to have MC or not, it is your job to support his decision and increase his comfort-level with the procedure. And finally, counselors are the front line in ensuring quality services. If men do not feel comfortable with their counselors and the information that we provide, then they will probably not elect to have MC. Also, we want men to have a positive experience in our centers so that they will refer their friends and family for MC services. Remember, the goal of this project is to increase the number of men accessing MC so we need to make sure that people come to view our services as high-quality.