SCALING UP MALE CIRCUMCISION PROGRAMMES
IN THE EASTERN AND SOUTHERN AFRICA REGION
TANZANIA 8TH TO 10TH JUNE 2010
Malawi Presentation
Introduction & Background
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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
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MC is Concentrated in Southern Malawi mostly among
the Yao(lakeshore area), mang’anja & Lhomwe with
strong Muslim influence.
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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
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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
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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
South
SITAN2009
Centre
MDHS2004
North
0
10
20
30
Prevalence of MC (%)
40
50
60
Stratified Analysis
Ethnic Group HIV among
circumcised
HIV among
uncircumcised
Yao
9.5
13.4
Hlomwe
13.8
16.4
Malawi DHS 2004
Accomplishment
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National MC consultative meeting held 2007.
National Task Force in place
 MOH
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Chairing
NAC secretariat
MC included in the HIV Prevention strategy
 MC
activities in the HIV Prevention Strategy operational
Plan
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Situation analysis done and completed
 Report
accepted and adopted by MC subgroup
Policy Environment
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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
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MC Cultural & religious link very significant.
MC driven by experts and elders
 Low
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involvement of young people in MC
Notable opposition to MC in the past.
 Traditional
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leaders and Christian community
Cross sectional data presents a complicated picture
( High HIV prevalence among the circumcising
community)
Opportunities
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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)
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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
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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.