Male circumcision, WTF? (what are the fundamentals?)

After heaps of requests from international fans, I’m finally ready to reveal the project that has brought me to Tanzania for the summer. This way at least, my friends can stop ending chat conversations and emails with ‘K go save some children!’, to which I can only reply ‘lol k thx bye!’ as they sign off, caught between feeling inadequate and not wanting to debunk their image of American medical students immediately eradicating poverty and disease by their mere presence on the continent. But anyways.

I’m in Tanzania this summer with a Johns Hopkins affiliated NGO that works on bringing innovations to practice in developing countries. Specifically, I’m here to help on an 8 week male circumcision campaign in the rural Iringa region of southwest Tanzania.

Before I go on, here’s a primer for the general audience. Over the past several years, three definitive randomized controlled trials (the most badass, legit kind you can do, for you non-medical folks) in sub-Saharan Africa have shown that circumcising adult males reduces their risk of HIV acquisition by 60%. SIXTY PERCENT. In fact, in all three studies, the differences in acquisition rates between the control group and circumcision group were so extreme that the trials were stopped early, since it would be unethical to allow the control groups to go on not receiving the procedure.

(If you’re curious about the science, the risk reduction has something to do with the high number of Langerhans cells on the underside of the foreskin, through which the virus particularly enjoys attacking and entering the body.)

When you factor in that circumcision is relatively low risk and inexpensive, you might conclude that circumcising as many men as possible in high HIV areas is a very effective strategy for preventing HIV transmission, which is what the WHO concluded in 2007. But now that the science is proven, the question becomes one of implementation.


(A branded truck advertising MC services. We'll be driving this around the countryside.)

The challenge is how to get the service to tens of thousands of men as soon as possible, which brings us to right now, when I’m about to embark on a 9 hour car trip from Dar es Salaam to Njombe, in southern Iringa, to kick off the 2011 male circumcision (MC) campaign. Although the Iringa Regional Health service offers circumcision services three days a week year round, they have contracted Jhpiego to help run an 8 week high volume campaign the will offer clinic six days a week to reach a high volume in a short period. This is the second year of the campaign: last year, the goal number of clients was 6,000, and the campaign ended up circumcising 10,000. This year, the goal is 20,000.

To reach out to and care for so many clients in a short time, especially in a rural area, the Jhpiego team uses several creative strategies. To generate demand in the community, the team created several radio ads, and employed a social marketing team to head to the field in advance of the clinic kick off.