1. The Centre for HIV and AIDS Prevention Studies
CHAPS-Voluntary Medical Male Circumcision
21st International AIDS Conference
Alfred Khehla Adams
Technical Director
MSc (PhD candidate)
Durban, 18 July 2016

2. Presentation Overview
Introduction
The Age-Pivot in
VMMC as a Gateway to Adolescent and Men’s Health
Clinical Set-up for Males
Costing
Conclusion

3. Introduction CHAPS a local NGO founded in 2010
Operates in South Africa and Swaziland
Focus is on service delivery, VMMC training, quality assurance, research and start-up assistance
500,000 circumcisions since 2010
Focus on year olds since 2015
Implementation of Innovative demand generation

4. 2014 CHAPS had not started. There is a slight increased in numbers after CHAPS started operating in Swaziland in 2015.

5. The donor introduced the age pivot in that’s why CHAPS tried out different innovative demand creation interventions. There is a clear increase in number of males circumcised in the age pivot.

6. Demand Creation Strategies (10-49 years)
A mix of piloted strategies:
Using football as a tool
Engaging private practitioners
Male Circumcision ambassador Dennis ‘Yuki’ Masina
Sensitizing teachers
Working with tertiary institutions
Using a mobile app to link males from HTS to circumcision
Lihawu Camps – Where culture meets biomedical circumcision
Soka soccer challenge. Trained by grass roots soccer to demonstrate to soccer players the protection offered by VMMC and condoms during sexual intercourse. Penalty shoot out and goal posts reduction.
PPs seem to be able to attract older males from companies etc. their facilities are perceived to offer better quality, no queues, flexible times
3. Yuki arguably the most successful soccer player to have played for Swaziland. Got circumcised by CHAPS and is an ambassador for the MC program in SD.
4. As gate keepers and influential messengers, CHAPS engages the teachers and sensitize them about MC. Address their concerns such as being absent from school after the surgery.
5. traditionally recruitment has been in schools (esp. primary schools). Chaps hired recruiters within Limkokwing to recruit their colleagues.
HTS is now focusing on the yield and CHAPS so a gap in this approach. Thousands of men are tested and found negative so we aim to link these men to circumcision through a mobile App – commacre.
As a medical anthropologist, I find this strategy interesting. Yes, VMMC is biomedical but seeking it is a social process and this approach aims to fill in the gap.

7. VMMC as a Gateway to Adolescent and Men’s Health
CHAPS has piloted VMMC camps with a local NGO (Kwakha Indvodza)
Target group are males aged years
Kwakha Indvodza focuses on:
Male Health Awareness
Male Community Responsibility
Financial Independence
Male health - Raising awareness of men and their vulnerable health e.g. alcohol abuse, promiscuity (toxic masculinities), poor health seeking behaviour related to socialization e.g. boys don’t cry, cheese boy
Encourage ideologies of respect, responsibility, taking care of females as ‘gentlemen’, GBV
Help males start up projects

8. Lihawu Camps in Swaziland
30 participants per camp (age years)
3 day male mentoring camp (age, sex specific)
Optional VMMC on the 2nd day (75% uptake rate)
Removing the emajaha (young men) from their communities
Swazi (Bantu) cultural elements e.g. lisango
Intensive messaging and SBCC sensitizations in a number of adolescent SRH and Life Skills issues
Offering VMMC under clinical conditions

9. Elements of the Lihawu Camp
Gender Awareness
Sexual Consent and rights for females
Masculinity and Health
Goal setting
HIV and condomization
Post-op care and conduct

10. Discussing males’ issues – tinkinga
Discussing males’ issues – tinkinga. Participants anonymously submit ‘problems’/ issues to be discussed in this dark forum where an older person such as a chief advises the males on the topics discussed.

11. Clinical Set-up for Males in SA
Studies in SSA show that clinics are perceived as spaces for women and children (Skovdal 2011, )
CHAPS aims to make the clinic a space comfortable for men by:
Providing unique clinic space for older and younger males
Offering male friendly material
Flexible times
Free Wi-Fi

12. Costing
As a local NGO costs have been low, less than 100 dollars per circumcision in SA
Low overheads expenses as a local NGO
Paying partners per circumcision
Lihawu Camp: 2,500 SZL/180 US dollars per MC in total (total)
Utilizing locum staff
Maximizing the MOVE model

13. Conclusion Improvement in reaching older males over the years
Demand creation remains crucial and still a challenge
Offering a comprehensive males’ health package attractive to men
Adding expanded NCDs screening (e.g. diabetes, cholesterol screening)
On the supply side, the MOVE model and use of locums is able to cope with increased demand
Making circumcision as a gateway to broadening males’ health and social responsibility
George et al 2014 article – KZN camps

14. The End, Thank you!