SCALING UP MALE CIRCUMCISION PROGRAMMES IN THE EASTERN AND

SOUTHERN AFRICA REGION TANZANIA 8TH TO 10TH JUNE 2010

Malawi Presentation

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

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.

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.

MC Prevalence by Region

0 10 20 30 40 50 60

North

Centre

South

Prevalence of MC (%)

SITAN2009

MDHS2004

Stratified Analysis

Ethnic Group HIV among circumcised

HIV among uncircumcised

Yao 9.5 13.4

Hlomwe 13.8 16.4

Malawi DHS 2004

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

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.

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)

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)

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.