The 22-year-old man had been waiting all night – sleeping outside in the freezing cold of Lesotho’s harsh mountain winter – and was now next in line to receive voluntary medical male circumcision (VMMC) services at Scott Hospital in Morija, Lesotho. He knows that getting circumcised reduces the risk of acquiring HIV, something that Lesotho, with a 23% HIV prevalence, desperately needs.
This young man’s determination to access VMMC services is becoming a common occurrence in Lesotho, where young men queue for services being rolled out and provided to clients at no cost in district hospitals with the support of the Lesotho Ministry of Health (MOH). The VMMC program in Lesotho was launched in March 2012, an effort funded by the United States President’s Emergency Plan for AIDS Relief through USAID and implemented by MCHIP.
In contrast to other countries, where rapid scale up of VMMC services has encountered problems due to lack of demand, cultural sensitivities, or insufficient integration with existing health systems, the Lesotho MOH and MCHIP/Lesotho’s step-by-step approach is already reaping rewards. Providers are seeing no drop in demand: between March and September of this year, the program performed 6,960 circumcisions!
To get the activities started, a two-week training in February updated Lesotho MOH staff on the WHO/UNAIDS/Jhpiego manual on Male Circumcision under Local Anesthesia . After this training period, service provision was organized by the MOH and MCHIP and initiated two days of every week. In April, the second training course took place, with two other hospitals prepared to provide services by early May. The program is currently operating in four hospitals.
Much of the program’s success is due to the strong leadership of the Lesotho MOH, as well as MCHIP working with—rather than apart from—the existing health system. MCHIP has also respected the cultural norms that surround circumcision, including its role in initiating Basotho males into adulthood. Knowing this, MCHIP was clear from the start that the VMMC program must be led by the MOH, and held preparatory meetings with traditional leaders to ensure that appropriate messages about the program were communicated.
VMMC uptake in Lesotho has the ability to change the course of the epidemic: modeling shows that just five male circumcisions will avert one HIV infection and save millions of dollars in care and treatment. The challenge now remains to keep demand for VMMC services high, and to ensure that VMMC becomes fully integrated into the national HIV prevention plan.