Bill & Melinda Gates Foundation

Male Circumcision: Kenya's HIV-Prevention Weapon

November 29, 2011

I have seen firsthand the tremendous progress my home country, Kenya, has made in the fight against AIDS, where 7.1 percent of adults between 15 and 49 years old are infected with HIV.

Part of this progress is due to the scale-up of male circumcision. One of the most promising HIV prevention tools, male circumcision reduces sexual transmission of HIV from women to men by 60 percent. As the Director for the Nyanza Reproductive Health Society (NRHS), I oversee male circumcision scale-up and training in Nyanza, Nairobi, and Rift Valley Provinces.

Kenya, now three years into its national male circumcision program, is making great strides. Since its launch in 2008, with the full backing of the provincial and national government, male circumcision providers have conducted 353,000 procedures across the country.

NRHS, with support from donors like the Gates Foundation and PEPFAR, is responsible for nearly half of them. Since our program launched in 2007, we have trained 1,700 health care providers and performed 175,000 circumcisions. But, Kenya is ambitious and hopes to complete 860,000 procedures by the end of 2013.

In order to reach this goal, NRHS is becoming more efficient. Through improved methods, we are shortening time between clients and maximizing the number of clients we see each day. We also conduct research with our colleagues in the Male Circumcision Consortium to identify ways to make male circumcision services even more efficient.

By employing pre-packaged medical kits, task sharing, task shifting, and other innovative mechanisms, we have decreased the time between surgeries from 40 minutes to about 10 minutes. The cost of the procedure, while free to the patient, has come down from US $65 to US $39 in the past three years. As a result of these efficiencies of scale and delivery, sites have witnessed a doubling of procedures—from seven or eight per day in 2008 to almost 17 on average today.

Increased efficiency must be met by increased demand. In order to reach more people, Kenya has launched mass media campaigns and hired peer educators at each facility. NRHS deploys teams to conduct mobile and outreach programmes in schools, fishing beaches, churches and other locations to reach a high volume of boys and men.

Despite incredible progress, significant challenges remain. We are struggling to reach “older” males. Currently, the large majority (80 percent) of NHRS clients are between the ages of 15 and 24.

In our hands, we have an incredibly effective and simple procedure to reduce HIV among men and their female partners. It is critical that we reach, and even exceed our targets. Success requires commitment and support from community leaders and local governments.

On this World AIDS Day, I am energized by the promise of HIV prevention tools and hopeful that my countrymen and women will join me in speeding an end to this terrible epidemic.

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