Abstract
Employing voluntary medical male circumcision (VMMC) within traditional settings may increase patient safety and help scale up male circumcision efforts in sub-Saharan Africa. In Zimbabwe, the VaRemba are among the few ethnic groups that practice traditional male circumcision, often in suboptimal hygienic environments. ZAZIC, a local consortium, and the Zimbabwe Ministry of Health and Child Care (MoHCC) established a successful, culturally sensitive partnership with the VaRemba to provide safe, standardized male circumcision procedures and reduce adverse events (AEs) during traditional male circumcision initiation camps. The foundation for the VaRemba Camp Collaborative (VCC) was established over a 4-year period, between 2013 and 2017, with support from a wide group of stakeholders. Initially, ZAZIC supported VaRemba traditional male circumcisions by providing key commodities and transport to help ensure patient safety. Subsequently, 2 male VaRemba nurses were trained in VMMC according to national MoHCC guidelines to enable medical male circumcision within the camp. To increase awareness and uptake of VMMC at the upcoming August-September 2017 camp, ZAZIC then worked closely with a trained team of circumcised VaRemba men to create demand for VMMC. Non-VaRemba ZAZIC doctors were granted permission by VaRemba leaders to provide oversight of VMMC procedures and postoperative treatment for all moderate and severe AEs within the camp setting. Of 672 male camp residents ages 10 and older, 657 (98%) chose VMMC. Only 3 (0.5%) moderate infections occurred among VMMC clients; all were promptly treated and healed well. Although the successful collaboration required many years of investment to build trust with community leaders and members, it ultimately resulted in a successful model that paired traditional circumcision practices with modern VMMC, suggesting potential for replicability in other similar sub-Saharan African communities.
Highlights
Evidence suggests that offering voluntary medical male circumcision (VMMC) within traditional settings could facilitate safer outcomes for traditional circumcision practices and increase male circumcision coverage.[1,2,3,4,5,6,7]
Due to their support for, and approval of, the medical circumcision performed by the VaRemba nurses, almost all eligible boys and men opted for modern VMMC, suggesting little reticence to accept modern circumcision within the camp context
The VaRemba Camp Collaborative (VCC) resulted from 4 years of persistent consultation and collaboration between ZAZIC, the Ministry of Health and Child Care (MoHCC), and VaRemba traditional leaders
Summary
Evidence suggests that offering voluntary medical male circumcision (VMMC) within traditional settings could facilitate safer outcomes for traditional circumcision practices and increase male circumcision coverage.[1,2,3,4,5,6,7] In Zimbabwe, the majority of people do not belong to ethnic groups that traditionally circumcise.[8]. Among the VaRemba, initiation camps are held every 1 to 2 years to complete the rites of passage from boyhood to manhood. In these camps, experienced traditional circumcisers typically perform male circumcision with the help of the community elders.[12] The initiation camp is traditionally held in the winter after the harvest season when the community can ensure enough food for the gathering. Joining the camp is voluntary, adherence to tradition compels most boys and men to join. Some older VaRemba men in the villages join the camp because they have not yet been circumcised or, had been circumcised medically but wish to participate in other camp rituals. Few additional details are known about the camp activities
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