1. Male circumcision in Rwanda Presented by:

2. Background Population: 9.3M HIV Prevalence : 3% MC Prevalence: 15% (15-49 years) MC integrated in the national HIV prevention policy since 2007 MC Partnerships: WHO, UNAIDS, UNICEF, USG, Jhpiego, Civil Society Organizations

3. Figure 1: Scenario for MC Service Expansion in Rwanda - Adult, Adolescent (10-19yrs) and Neonatal MC Programme Sources: Rwanda NIS 2009; Rwanda NSP 2009-2012

4. Implementation Status Leadership:  NAC (CNLS) coordination of MC activities  MOH responsible for MC in health facilities  TRAC Plus responsible for development of MC tools  Technical Working Group (TWG) since 2008(National and Partners)  MC focal person in TRAC Plus & CNLS.

5. Implementation Status… Situation Analysis: *3 studies: -Cost & effectiveness of MC -Facility readiness assessment (data analysis: Ongoing) -MC KAP study (data analysis) *DMPPT Model (ongoing)

6. Accomplishment Policy & Regulation :-MC integrated in National HIV prevention Policy; -MC guidelines under approval. Advocacy with civil society umbrellas (with support from AVAC/IHV) QA,M&E framework under discussion

7. Accomplishment… Training: 2 Programme Managers ; 6 National trainers;50 MC service providers, 91MC counselors (military HF) Service Delivery: MC in 9 Military sites (542 circumcised men since 10/2009 to 04/2010), MC pilot project is planned in 2 districts hospitals (Musanze & Nyanza)

8. Lessons Learnt Political engagement / commitment of stakeholders. Community acceptability is likely to be high Existing of certain cultural/sexual practices that could undermine MC impact and or acceptability Willingness of women to be involved in MC rollout

9. Challenges The operational plan under discussion with technical support of UNAIDS; Insufficient medical staff and mobility of trained staff Insufficiency of MC kits High cost of the MC / Funding availability Task shifting Communication plan Service coverage and M&E framework

10. Way Forward Finalize DMPPT model: Operational Plan Evidence based policies Capacity building Development of communication plan and tools Modeling effective service delivery at district level

11. Support need to scale up Technical expertise:  Operational plan;  BCC;  Capacity Building;