1. 8-10 June 2010 Arusha, Tanzania By AYANDA NQEKETO National MC Coordinator Ministry of Health, Swaziland

2.  National MC policy was approved in August 2009  Current plan is to circumcise 111,000 adult men (80% of the adult male population aged 15-24) over 5 years  Increasing the capacity of public and private MC service providers  Utilize fixed and mobile sites  Scale up has been slow  Since 2007—only xx adult MCs and xx neonatal MCs have been performed  At the current rate it will take longer than 5 years to reach our targets Ministry of Health, Swaziland

3.  MOH engaged the USG and other key stakeholders in dialogue around accelerating the scale up of MC  In Feb 2010, the ASI proposal was presented the Cabinet  The Cabinet passed a resolution and requested assistance from the USG to implement  In March the GKOS requested the Task Force to prepare a detailed implementation plan Ministry of Health, Swaziland

4. Partner with USG for funding and technical expertise Ministry of Health, Swaziland Phase 1Preparation and piloting3-6 months Phase 2Regional implementation of ‘full scale’ ASI 1-2 months Phase 3Full scale7 months

5.  Three key challenges will affect the success of the ASI: 1. Existence of trained human resources- Limited 2. Adequacy of the facilities- Limited 3. Acceptance of the MC campaign  With a mainly rural population, MC services will likely need to be taken to the people rather than relying solely on the people traveling to fixed MC service-delivery sites Ministry of Health, Swaziland

6.  The target population will be 161,291 males aged 15-49 years old  Reasons for expanding the target group include; the prevalence of intergenerational sex, age of first sexual debut, and HIV incidence Ministry of Health, Swaziland Total Males Aged 15-49 236,594 Estimated circumcised (8% prevalence) 18,928 Estimated uncircumcised (92%) 217,666 Estimated HIV-infected (25.9% prevalence) 61,278 Estimated HIV-negative (74.1%) 175,316 Total needing circumcision (not circumcised and HIV neg) 161,291

7. Ministry of Health, Swaziland

8. Hhohho Shiselweni Manzini Lubombo Matsanjeni Mhlambanyatsi Motjane Matsanjeni1 Sithobela Ndzingeni Mayiwane Khubuta Gege Mbabane East Mthongwaneni Zombodze Mafutseni Shiselweni Sigwe Mukhiweni Mangcongco Lubuli Timpisini Ngudzeni Nkwene Hlane Sandleni eKukhayeni Siteki Nkaba Hhukwini Ntondozi Ludzeludze Nhlambeni Lomahasha Hosea Ntfonjeni Manzini South Mhlume Mtsambama Manzini North Mahlangatja Lobamba Mbangweni Mpolonjeni Maseyisini Maphalaleni Mahlanya Mhlangatane Mandlangempisi Ngwempisi Pigg's Peak Dvokodweni Mbabane West Kwaluseni LaMghabi Siphofaneni Lavumisa Mbabane Piggs Peak Mbabane East Siteki Good Shepherd Sihobela Mkhuzweni Matsanj eni Nhanagano Hlathikhulu Mankayane R.F.M. Hospital Mhlambanyatsi Dvokolwako

9.  MC Task Force formed an ASI sub-committee and four workgroups  Mapping and policy  Logistics  Human resources  MC service delivery including M&E Ministry of Health, Swaziland

10.  Main office / warehouse  3 regional offices / warehouses  27 clinical teams and support staff  > 500 staff and volunteers  4 fixed sites - operational all year  10 clinical teams  Total MCs 52,300  13 mobile sites – operational 3 – 10 months  7 clinical teams  Total MCs 32,000  507 outreach events – operational for one week  10 clinical teams  Total MCs 44,700 Ministry of Health, Swaziland

11.  Procurement and supply chain management  Recruitment and deployment of volunteers  Adequacy of staffing plans  Implementing more efficient clinical methods  ASI workgroup performs a methodical review of each pilot  Lessons learned incorporated in subsequent pilots Ministry of Health, Swaziland

12.  Ministry of Health  National Male Circumcision Taskforce  USD /PEPFAR  USAID Health Policy Initiative (HPI)  WHO / UNAIDS  MC partners in Swaziland  Communities in Swaziland Ministry of Health, Swaziland