1. Scaling-up male circumcision programmes in the Eastern and Southern Africa Region Country update meeting
HIV Testing and Counseling and
Male Circumcision
Experiences from Zimbabwe
Karin Hatzold, MD, MPH
Director HIV Services PSI Zimbabwe

2. Issues HTC/MC Low uptake of HTC in several MC country programs
Risk of increased HIV transmission if large numbers of HIV + become circumcised and would not practice safer sex?
T&C as “precondition” for MC might prevent uptake because of fear of positive status
Stigmatization of HIV + men,
who will not benefit
from the intervention?
HIV + men might seek MC services outside clinical settings?
Integration and linkages between HTC and MC Services
Re-testing for HIV at MC site of previously tested individuals

3. T&C uptake among MC clients in selected countries
MC Country program
Number of MCs conducted
Proportion of MC clients tested for HIV prior to intervention
Proportion circumcised HIV + status
Proportion of tested, who tested at the MC site
Botswana
6100
89%
100%
Kenya
120, 000
56% 3%
70%
Namibia
350
94%
98%
Swaziland
9309
88%
2 %
Tanzania
4702
99%
0.8%
Zambia
29, 500
62% overall,
80% in ≥16 4%
Zimbabwe
6070
0.5%
28%

4. Results from Zimbabwe

5. PITC and VCT in Zimbabwe
40% of the adult population in Zimbabwe knows their HIV status*
Large network of VCT services centers and outreach teams since 1999
PITC implemented since 2007, over 800 health care facilities are providing T&C
High level of awareness about HTC through Mass Media and IPC communications
1 Million Zimbabweans tested per year, 35% through VCT, 65% through PITC
*Preliminary results from population based survey of year old males and females conducted in six districts in Masvingo and Mashonaland East.

6. T&C as entry point for MC
New Start nationwide network of T&C centers and outreach teams
Tested 1.9 Million Zimbabweans, 40, 000 monthly, 50% are men, 75% test HIV negative
MC counseling integrated in post-test counseling session to recruit HIV negative men for MC at 5 pilot sites
High uptake of MC services when offered as additional HIV prevention intervention in counseling session
Booking for MC at the T&C site and referral
Communication between T&C and MC sites
Follow up with booked clients

7. Routine Offer of HIV testing
Quality of counseling process
Group education session
Individual counseling session
Counseling guides, flipcharts
Quality of counselor
Use of nurses & other professionals
Intensive Training and Refresher
Courses
Ongoing Supervision

8. MC service client flow VISIT 4 VISIT 1 VISIT 2 6-wk Review &
Counseling
One-on-one MC/ HTC
Counseling
2-day Review
&
Counseling
Reception
MC Procedure
VISIT 3
Group education
Routine offer
Testing
Post-op Recovery/
Counseling
Pre-op
Assessment/
Counseling
7-day Review
&
Counseling
This chart represents the client service flow through our MC program in Zambia. As you can see there are multiple opportunities for clients to discuss MC and other sexual health issues. 8 8

9. MC Communication messages
Clear messaging on benefits of MC as additional HIV prevention intervention for HIV negative men, “primary” prevention
T&C not mandatory, but recommended

10. MC and HIV + men
In-depth counseling on known risks and benefits of MC with HIV positive status
If client insists on MC, clinical staging and CD4 cell count to check medical condition
Discussing care and treatment options with HIV positives
Prevention and treatment of opportunistic infections
ART
Positive Living strategies
MC might not be indicated or the best option
Provision of on-site CD4 cell count using point of care devices
Adequate referral into continuum of care

11. Acknowledgements
MC programs in Botswana, Kenya, Namibia Swaziland, Tanzania, Zambia
AIDS and TB unit MOHCW Zimbabwe
PSI New Start network
Clients accessing T&C and MC services in Zimbabwe

12. Get tested for HIV Get circumcised