1. School of Medicine and Dentistry –James Cook University
Taking medical circumcision to male initiation ceremonies in Yangoru-Sausia, Papua New Guinea
Clement Manineng
School of Medicine and Dentistry –James Cook University

2. East Sepik Province –Papua New Guinea

3. Papua New Guinea Rugged Geography 85 % of people live in rural areas
Over 700 cultures and languages
About 50% adults illiterate
Low health indicators
High Corruption
Booming economy

4. HIV in Papua New Guinea
Estimated more than 90% HIV infections in Pacific are in PNG
21,459 people living with HIV in 2013
HIV prevalence in 2013 was 0.52%
74% eligible adults on ART, 39% eligible children on ART
Main route of transmission heterosexual
Southern (excl NCD) 0.63%
Highlands 0.60%
Momase 0.25%
New Guinea Islands 0.26%
NCD 1.04%
It is estimated that more than 90% of HIV infections in Oceania happen in PNG. In 2013, 21,459 people were living with HIV. Among adults (15 years and older), the rate of HIV in PNG was 0.47%. This is likely saying that about 1 in every 20 adults in PNG are living with the virus. The main route of the transmission of HIV is heterosexual sex. Heterosexual sex is sex between a man and a woman.
NACS 2013

5. Male circumcision and HIV prevention
3 randomized controlled trials show HIV prevention among circumcised men
WHO recommends male circumcision scale up in high HIV and low male circumcision settings.
2 studies in PNG show penile cutting practice exist in PNG and non-circumcised men were willing to be circumcised
However, PNG’s challenges warrants further studies
However, between 2005 and 2007, 3 randomized controlled trials in Africa found that the risk of HIV infection in circumcised men were reduced by up to 60% compared to non-circumcised men. These findings led to WHO recommending the scale up male circumcision programs in areas that had high numbers of HIV cases and whose majority of male population remain uncircumcised. In those times, Papua New Guinea was experiencing high number of new HIV infections and there was no information available on the status of circumcision among PNG men. This study was therefore conceived in line with WHO recommendation. We wanted to firstly know about the acceptability of male circumcision in the country.

6. The boy becomes a man
from child to adult: from carefree to responsibility: from being a dependent to being independent
Sourced from:
and

7. Urethral Bleeding in Yangoru-Sausia, Papua New Guinea
Sourced from:

8. Initiation ceremony outlawed
Risks of permanent injury and death at initiation ceremonies
Worship of ancestral spirits was against Christian teachings
Stopping initiation also took away opportunity for counselling especially on sensitive issues including sex, marriage and family planning.

9. Initiation ceremony being revived
Inclusion of;
Medical Male Circumcision
HIV education
HIV testing

10. Medical Circumcision at initiation ceremony
Conducted by medical team
Used standard surgical MC procedure
Conducted 64 circumcisions
Only 2 complications –pain and bleeding

11. Community response to initiation ceremonies
Clan elders shed tears
Ceremony house is built
Counsellors and Presidents voice support

12. Circumcision at initiation ceremonies
The Challenges
The enablers
Insect screen
Sterilization of instruments
Supplies
Medical team
Community leaders were willing
Men in medical team originate from the area
Program led by provincial HIV response team

13. The Outcome 64 men with better chance of avoiding HIV
64 men with better chance of succeeding in life
64 men who will value and respect women
Lost tradition is revived
Program fits very well into local culture
Provincial HIV Response team achieves community participation

14. Assessments of modified initiation ceremony
Cultural Acceptability
Feasibility –Health standards and economics
Impact evaluation

15. Culture =Identity