Reaching Men with a Minimum Package

Removal of the foreskin is only one element of a comprehensive SMC Programme. PEPFAR and other donors have a ‘minimum package’ of services that programme implementers must provide.

This starts with community engagement and mobilisation during which we have a great opportunity to reach men with a broad public health message, whilst of course focussing on many aspects of reproductive health. Men are very often not present at other ‘outreaches’ that may be more focussed on water and sanitation, malaria or family planning and child health.

Men registering for circumcision are first offered voluntary HIV counselling and testing. Knowing your status is essential and for many of these men this may be the first time they have been tested. Those who test positive are enrolled onto treatment programmes.

The men have a chance to learn more about how to avoid HIV and other sexually transmitted infections. They are offered STI screening and provided with any necessary treatment and care.

Men are informed about the correct and consistent use of condoms and why this is such an important part of prevention both before and after circumcision.

All of these services are provided free of charge.

Alison and Michelle Raise more than £3,300

Alison and Michelle

Alison and Michelle raised more than £3,300 from their family and friends who sponsored their recent marathon in Edinburgh.

These funds will be used to continue supporting the STI clinic in Makindye division, Kampala. This clinic provides counselling, testing and treatment, free of charge, to those that could not otherwise afford to access such care.

The clinic is an integral part of our Touch Namuwongo Programme which also provides counselling, testing and treatment for HIV/AIDS and TB. We are currently planning to extend these services to include safe male circumcision.

In recent years about 20,000 adults living in Makindye division have accessed services from the Touch programme.

Our thanks also to Helen for her continued support for the STI clinic.

1 in 13 Ugandans are HIV+ and Reactions to my SMC Post

We received a number of comments after my initial posting about the Safe Male Circumcision Programme at IMG.

It’s true that SMC (MMC, VMMC) has its detractors. There are some that do not consider this procedure desirable and others who are concerned that circumcision may in fact lead to an increase in HIV infections and the spread of STIs.

Some have called into question the validity of the initial three research studies, often quoted as the reasons for these national SMC programmes. We welcome further research studies, designed to ensure that these concerns are addressed. As we embark on this programme in Uganda, we are keeping research and evaluation right at the heart of what we do.

When the BBC reported the news that in Zimbabwe MPs were coming forward for SMC, it noted these concerns:

But it is not the whole solution. Promoting safe sex, providing people with HIV testing services and encouraging the use of male and female condoms are all seen as equally important.

Some experts also say there is a danger in sending out a message that circumcision can protect against HIV because it could lead to an increase in unprotected sex.

We agree, it is essential that SMC is made an integral part of a comprehensive prevention programme. We are ensuring that both men and women understand that male circumcision does not give full protection and other preventive measures must still be taken, in particular continued use of condoms and knowing your partner’s status.

TNP ABC - Put it on like this

We are using the SMC programme as a unique opportunity to reach men who are often not present at our other community health outreaches. We are combining each of the reproductive health messages with the SMC message, covering e.g. HIV, STIs, Family Planning, PMTCT, the need for and importance of ante-natal visits and attended delivery. In that way we hope that both men and women will gain a better, more complete, understanding of all these related matters.

These programmes are hugely important in Uganda. Just this week the Ministry of Health reported new data showing that HIV/AIDS is on the increase:

The number of Ugandans infected with the HIV virus has increased by 100 per cent in the last seven years, it was announced yesterday. Results from the 2011 Uganda AIDS Indicator Survey show that one in every 13 Ugandan adults has HIV. The prevalence rate has surged from 6.4% in 2005 to 7.3%.

Joshua Businge from the AIDS control Program from the Ministry of Health attributed the incidence to multiple sexual partnerships (MCP) and failure to use condoms as one of the major reasons why the figures were going up.

You can read more about this announcement here and here.

Male Circumcision Programme in Tanzania reaches 100,000

The Maternal and Child Integrated Programme, MCHIP, announced this week that its safe male circumcision programme in Tanzania had now provided services to 100,000 clients. You can read the original press release by clicking on the image below.

MCHIP Logo

Estimations show that 16,000 future HIV infections will be averted between now and 2025 as a result of these 100,000 circumcisions. If accurate this means that for every one pound or one dollar invested in the SMC programme, about 14 will be saved in future treatment costs.

I shared this news with our own team and here’s the reply back from Francis, the in-charge at Hope Clinic Lukuli:

This is extremely very good news for East Africans. Overall, I think the success in TZ can be attributed to the immense family support for men going for VMMC as the article does note. For example, a son and his mother accompanying a father to the VMMC CENTRE and also availing himself (son) for the VMMC is extremely awesome. Also, not forgetting the hard work of the local medical team, the nurses.

For Uganda, there is a lot to learn from TZ especially how can we have full family support for men in Uganda to get the numbers we desire for VMMC? Also can we have work places support the VMMC so that men who work can benefit fully from this? Can registering, HCT and STI treatment and carrying out the procedure in one day work better than giving appointments? Lastly, why do some men register and never show up?

VMMC – voluntary medical male circumcision

SMC – safe male circumcision

These are the same, just referred to differently in different places.

HCT – this is the counselling and testing for HIV, an integral part of an SMC programme and sometimes also referred to as VCT.

Alison and Michelle – Edinburgh Marathon

Alison and Michelle - Just Giving page

Alison writes:

Alison and Michelle have chosen to pound the streets of Edinburgh to raise money for the Suubi Trust, a charity that they know is making a huge difference to many of the most vulnerable people in Uganda through its numerous healthcare projects.

Having just recently spent 18 months volunteering in Uganda as a doctor, Alison was privileged enough to be involved in many of these health projects and so has first hand experience of the amazing work that they are doing despite very limited resources. Visit their website http://blog.suubitrust.org.uk/ for more details.

We know that every penny you donate will make a huge impact to many lives in Uganda so with your support we will make sure we stay the course, even if it is on our knees!!

Please click on the photo above and help support Alison and Michelle…

Dr. Alison Raising Funds for Touch Namuwongo

A recent post by Dr. Alison described how she helped to establish an STD Clinic within the Touch Namuwongo Programme in Kampala.

This summer Alison, Alan and their family raised £1,171 to help support this programme by speaking at a local church lunch and hosting a Ugandan party for supportive friends in her native St Albans.

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Alison (on right in photo above) sent us this message:

We wanted to update you after our latest fundraising venture on 16th July. It was a fantastic evening of fun and frolics in the community centre around the corner from us and was well-attended with over 80 people. Whilst people could still concentrate, we kicked off with a talk from us about our time in Uganda including the work of the Suubi Trust and the Royal Pride School in which Alan was involved. We raised a total of £1168 which we will split evenly between the 2 causes (£584 each). Everyone came in the Ugandan colours and some draped in the Ugandan flag.

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(Alison’s husband Alan is in the centre in the photo above)

So, in summary, this means that the first church event raised £587 and this latest event raised £584 – a total of £1,171.

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Our thanks to Alison and all her friends for their generosity and continued support; this will help to make a difference for many of our Touch clients receiving care at this clinic.

Dr. Alison (VSO) working with Touch Namuwongo

Alison with her familyAlison Cowan, a GP from the UK, and her family have recently returned after a fabulous 18 months in Uganda working with the IMG group through the charity VSO. She came to Uganda initially to facilitate the training of medical staff across the various IMG primary care clinics. Through this work she came to appreciate the enormous burden of sexually transmitted disease (STD) and its devastating consequences within Uganda and especially Kampala and recognised the need for a comprehensive sexual and reproductive healthcare service. So, once her original placement objective was fulfilled, she extended her placement to work with the Touch Namuwongo Team based at the International Hospital of Kampala (IHK), within the neighbouring communities, to tackle this growing problem of STDs.

Even though STDs are very prevalent in Kampala, and are responsible for a lot of death and disease, very little attention and minimal resources are focused on this area, beyond HIV. The Touch Namuwongo team work with the poorest members of the Kampala community local to IHK and offer services for HIV, TB and STDs. With respect to STDs, prior to Alison’s involvement, the team were just able to treat the symptomatic cases in their hospital clinics and community outreach. However, this approach was only scratching the surface of the problem as 50-70% of disease can be silent. There was no system or resources in place to identify and screen those members of the community most at risk from these diseases and who were often without symptoms. As well as unknowingly transmitting these diseases on to others, the presence of STDs also facilitates transmission of HIV so further fuelling the HIV epidemic. Alison developed a risk score tool capable of identifying such members of the community and which would also then appropriately target their limited resources to the most in need of treatment. Despite resources being very stretched, with the enthusiasm and commitment of the Touch Namuwongo team, the support of IMG and the help of kind donations they were able to get establish a comprehensive service which identified both symptomatic and asymptomatic disease.

Alison also obtained some funding from Oxford University to carry out a research project that aimed to derive and validate this risk score tool. As an associated benefit, the study also funded a large volume of screening and medicines for treatment of STDs in the data gathering process.

The Touch Namuwongo team took on the extra burden of work involved in the study without complaint and worked tirelessly to deliver the service and also produce the data which is in the process of being analysed to develop an effective protocol going forward.

Alison with Immaculate one of theTNP team

Initially Alison was heavily involved in the actual running of the clinics, but by the time Alison returned to the UK, the team was delivering the service without any additional input and continues to do so with great effect, despite the challenges and hard work this entails. Even though the clinics are already very busy, the team recognise what a valuable service it provides and so continue to reach out to the community to encourage others to be screened and treated, especially those communities where the need is greatest. They have got a good relationship with the local commercial sex workers, who continue to attend the clinics and who themselves are becoming advocates of the service.

The research funding has now drawn to an end and so there is a desperate need for on-going funding to continue to deliver this valuable service. Alison continues to raise funds for the STD programme through Suubi Trust, recently speaking at a local church lunch and is soon hosting a Ugandan party for supportive friends in her native St Albans.

The team with some added extras Alison’s children

Advent: Day 3 Touch Namuwongo

I really like this photo which I took during an open day for the Touch Namuwongo Programme at IHK. It was just great to see so many of the local children taking part in the events in the hospital grounds.

Our vision is that IHK would help to serve all of the people living in our Division, not just those that can afford to pay for it.

Touch has become a more holistic programme over the last few years thanks to the funds from Civil Society and great work and committment by the team and it’s leaders.

Having started as a simple HIV/AIDS testing programme this has now grown to provide HIV treatment, family planning, TB diagnostics and treatment, screening services for STIs and cancers. A recent initiative resembled “Dragon’s Den” helping to support the community volunteers in their income generation ventures.

“…at the heart of the community with the community at its heart”

I wish it were that easy!!

Dr. Alison has been a great help recently on our Touch Namuwongo programme. She has helped to establish some new treatment guidelines, especially for cervical screening and the STI clinic. She has just posted this on her blog

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…front page headline of a national newspaper yesterday!! Then another bit of classic primary prevention advice follows – another common belief as to how to avoid contracting HIV. It’s no wonder the HIV prevalence is 6.4% and climbing in Uganda!! It is with this in mind that I am appealing for funds to continue the comprehensive STI service that we have developed for the local community. STI control is proven to lead to a 40% reduction in transmission of HIV, so in Kampala, where STI prevalence is estimated to be about 9%, a comprehensive STI service can make a huge difference. Sadly, the funds through IMF (the charitable arm of the organisation) are limited and so if anyone feels the urge, donations would be most welcome via the following websites: Suubi Trust Blog or  Making a donation to Suubi Trust, earmarked for the STI clinic. £10 provides screening and treatment for 1 person with obvious knock-on benefits for that person’s sexual contacts too… so more for your money!!! If you are able to donate, drop me a line and I can keep you posted of how your money is used (whilst not being too graphic of course!)
Thanks to those who have already donated to this cause.