Gaborone, Botswana – When Kopano Matlhape gave birth to a new baby boy on January 3rd, she called him Tyrone – a name with Greek origins meaning “sovereign” – to let the world know there was a new king in town. Like any new parent, she has big dreams for her son’s future and couldn’t help giving him a name that reflected that sentiment.
Above all, the young mother wants to ensure her little king grows up healthy, which is why she decided to have Tyron circumcised. As a parent of a child in Botswana, a nation with the second highest HIV prevalence in the world, the decision just might save his life.
“I wanted to give him the chance to live freely and not worry as much about diseases,” the 22-year-old mother said, referring to the studies that have shown circumcision helps decrease the risk of HIV and other sexually transmitted infections in males. “Of course, we know this doesn’t mean he is free to do anything, but it does give him a head start in the world.”
Baby Tyrone was among the first infants in Botswana circumcised with one of two newly introduced medical devices for infants rolled out by the Ministry of Health earlier this year. Doctors and midwives were trained in January by experts from the U.S. Centers for Disease Control and Prevention (CDC). The new procedure is bloodless and requires no anesthesia or suturing.
Health officials say that not only will infant circumcision help protect boys from HIV when they become sexually active later in life, but that it also protects infants and boys from serious health complications such as urinary tract infections and paraphimosis, a condition that can lead to pain and swelling of the penis and may require surgery.
“He was a brave little boy,” said Matlhape about her son’s experience. “I really expected he would be crying the whole day and night, but he was just quiet. It was a fairly quick procedure, and I am happy we did this.”
The rollout of Early Infant Male Circumcision in Botswana may be one of several indications that the Safe Male Circumcision (SMC) program – once hampered by poor performance and negative media portrayals – has turned a corner in Botswana.
Between April 2013 and February 2014, the national SMC program recorded 42,679 circumcisions, about 85% of its annual target and 10,000 more than the previous year.
More targeted demand creation campaigns and a fleet of new mobile outreach clinics may help explain the recent upsurge in voluntary circumcisions in Botswana. Or perhaps it’s the promise of new SMC devices that make the procedure easier and faster.
Conrad Ntsuape, the national coordinator of Safe Male Circumcision in the Ministry of Health, would rather say that the improvements are part of the natural growth experienced by any program.
“When you start a new program you expect a low turnout at first, but when the program begins to mature then you would expect to see people start coming in larger numbers,” said Ntsuape. “Our challenge now is one of service provision. We can’t meet all of the demand that we are creating.”
The U.S. government through the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported Botswana’s SMC program from its inception in 2009 with nearly $25 million and technical assistance over the past five years. In 2013, PEPFAR restructured its support to a single-partner model and chose Jhpiego, a development organization affiliated with Johns Hopkins University, as the single implementing partner for all CDC-funded activities related to the SMC program.
A new long-term communications strategy has helped improve and focus demand creation, Ntsuape says. School-based campaigns have been especially successful, but so have the house-to-house campaigns that allow mobilizers to engage with men on a personal level. “The key there is the interpersonal communication. You are reaching them at home, with their families, and there is a component of counseling involved there,” he said.
In October 2013, the World Bank purchased five mobile SMC clinics for the Ministry of Health to reach remote areas of the country. The mobile clinics are based in Tsabong, Letlhakeng, Maun, Serowe and Kasane with the District Health Management Teams (DHMTs) placed in charge of them.
The government also plans to roll out the PrePex male circumcision device following the completion last year of a six-month pilot study sponsored by PEPFAR. The medical device is placed on the penis with no cutting of the foreskin involved, and allows men to continue working with the device in place for seven days.
As for infant circumcisions, the national program began in late January and has already recorded more than 250 completed procedures. The two new devices, Mogan Clamp and AccuCirc, are being administered on healthy newborns as early as eight hours after birth. With help from CDC Botswana, the MOH is training doctors and midwives – as the first line of contact with babies at maternity clinics – in Gaborone, Ramotswa, Mochudi and Francistown.
“If we can integrate infant circumcision into the maternity wings and convince mothers that this is a good idea, this one can be a big win,” says Ntsuape.
The decision to adopt the new devices followed a lengthy consultation process that focused on acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts that was conducted by the governments of Botswana and United States through the Botswana-Harvard Partnership in 2008. The results of the survey showed that 96% of mothers in Botswana would accept early infant circumcision for their babies.
“This may be one of our best chances to achieve an AIDS-free generation,” said Ntsuape.
