1. Styling Up VMMC Promotion: The Mwami Mulembe Campaign Stephen Mugamba Amos Zikuusoka Cheryl Lettenmaier

2. Background Mwami Mulembe Campaign Implemented by Rakai Health Sciences Programme (RHSP) and The Johns Hopkins Center for Communication Programs (CCP) Funded by Bill & Melinda gates Foundation Implemented in Rakai district, Uganda

3. Background 2012 national VMMC promotion campaign RHSP educated men about VMMC through town hall meetings & radio announcements By 2012, RHSP had done 30,000 VMMCs over a 10 year period 32% non-Muslims had VMMC Men coming for VMMC were: –Disproportionately younger (≤19) & –With lower risk behavior profiles HIV prevalence in Rakai 12.2%

4. Qualitative Research – “ The Problem with Men”* Satisfied VMMC clients do not discuss VMMC Misconceptions: –VMMC requires a 6 month healing period –VMMC causes persistent pain, decreased sexual satisfaction and infertility. Information/messaging via town hall meetings and radio focused on health aspects. Health promotion approach was not resonating with men. *funding: BMGF and NICHD RO1.

5. Campaign goal Increase uptake of VMMC, HCT, condom use and HIV care and treatment among men in Rakai by repositioning these practices as stylish and desirable for the modern Ugandan/Rakai man.

6. Audience: Uncircumcised men 25 – 35 years of age Ronald is a 30 year old P.7 leaver. He is a farmer in a rural area in Rakai district. He has 2 wives and 5 children but also extra marital partners. He spends much of his free time “drinking” and watching football. He desires to see that his children grow up in good morals and in fear of God. He believes in success and looks at the rich men in the town as his role models. He listens to soccer, politics and music on the radio, and occasionally goes to the trading centre (town) to watch soccer at the video hall (Kibanda). He hates using condoms because he wants to have many children and he enjoys sex more when it is “live”. He has never discussed with any of his wives/partners about HIV prevention, has never had an HIV test, and he is not circumcised.

7. Message Strategy Testimonies from satisfied clients A Stylish Man knows what he wants in life and does nothing that jeopardizes his plan Correct misinformation about VMMC: healing time, pain, sexual satisfaction Women are attracted to “Mwami Mulembe” who is strong, brave, healthy, knows what he wants from life. Women fancy men who are circumcised because they are cleaner and more sexually satisfying.

8. The Man Van arrives in town!

9. Approach District wide implementation through mass media. –Radio game shows recorded during “Man Van” activations –Popular DJ mentions. “Man Van” activations in 50 village clusters: –“Mwami Mulembe” weeks –Use of services allowed entry into “Mwami Mulembe” game –VMMC outreach services linked Testimonial videos at video clubs

10. 21% increase over ~1.5 years 46% increase over ~1.5 years

11. 2005 2007 2009 2010 2011 2012 2013 2014 Stylish Man Pilot

12. Key Learnings Coordination between demand creation and service delivery teams improved impact Locally designed strategies, messages, materials improved relevance Routine monitoring and feedback allowed for immediate changes Older men in particular need to feel “invited” to participate in events: –Personal welcome and escorts –Segregate services for men and those for women and children

13. Take Charge of life – Be a man of style