Category Archives: Demand Creation

Namibian Primary School Receives Platinum Certificate for VMMC Saturation

Facing Ashitenga Primary School students at the VMMC certificate ceremony are, from left to right: Levi Vries, Education Inspector for Oluno Circuit; Lusia Ndemuweda, I-TECH Demand Creation Coordination Nurse; Ashitenga Principal Edward Asser; Frieda Mupetami, a representative of Okatyali Constituency office; and Life Skills teacher Teopolina Mupetami (in red).

In Namibia, the prevalence of HIV infection among adults aged 15 to 49 is nearly 14%.[1] A key component of national efforts to prevent the spread of HIV is voluntary medical male circumcision, or VMMC, which has proved to reduce the rate of male-to-female transmission by upwards of 60%.

Since 2010, the International Training and Education Center for Health (I-TECH) has supported the VMMC efforts of the Namibian Ministry of Health and Social Services (MOHSS) in the Oshana and Zambezi regions. I-TECH not only supports health care worker training in the provision of VMMC, it is also engaged in critical efforts to create demand for the procedure.

A key element of these efforts is the recognition of schools and school leadership who are supportive of VMMCs. In February, Ashitenga Primary School in Oshana Region was awarded a platinum certificate by I-TECH Namibia for achieving 96% saturation of boys receiving a VMMC. Platinum is the highest honor, with bronze signifying 55-69% saturation, silver awarded for 70-79% saturation, and gold given for 80-89% saturation.

Present at the event was the Oluno Circuit Education Inspector Levi Vries. In his remarks, Mr. Vries encouraged other schools to emulate Ashitenga’s good example. He emphasized the importance of student health to attaining educational goals and urged students to spread the VMMC message to others in their families, villages, and neighborhoods.

As part of the Life Skills curriculum, older boys are instructed on HIV prevention, while the younger boys are taught personal hygiene – messages that are reinforced by I-TECH community mobilizers. Teopolina Mupetami, the Life Skills teacher at Ashitenga, encouraged Life Skills teachers at other schools in the area to support the VMMC program. Ashitenga principal Edward Asser echoed the importance of the school’s recognition; he promised to display the certificate proudly in his office.

Three of the circumcised students were interviewed by the Ministry of Information Communication and Technology, which is charged with spreading the message about “the smart cut” in the government media. The boys responded that “they feel clean and protected from sexual related disease,” said Helena Ferdinand, I-TECH community mobilizer. The students prompted boys at other schools to enroll in the VMMC program and expressed their satisfaction with the service.

“The atmosphere at the handover was joyful and a lot of excitement,” said Ms. Ferdinand. “The principal indicated that they will continue to work hard to get a second platinum certificate.”


HIV Testing Services in Botswana

I-TECH Botswana conducts facility-based HIV testing at selected PEPFAR supported scale-up sites in seven PEPFAR districts. Testing is carried out by Health Care Assistants and includes expanded provider initiated testing, counseling, and partner notification. In addition, I-TECH Botswana conducts regular continuous quality improvement (CQI) visits at I-TECH-supported facilities and provides support for linkage to care. Continue reading »

Case Finding and Retention in Care in Mozambique

I-TECH works with the Mozambique Ministry of Health (MISAU) to expand a pilot project to provide an assisted partner services intervention. The project is aimed at encouraging patients newly diagnosed with HIV infection to disclose their status to their partners, and bring them to the clinic for testing. Continue reading »

VMMC for HIV Prevention in Namibia

I-TECH assists the Ministry of Health and Social Services with the expansion and provision of voluntary medical male circumcision (VMMC) as an HIV prevention option. This support started in 2008 with the development of national guidelines and training materials, followed by national trainings of health care workers. In 2015, this support expanded to include direct service delivery in the Oshana and Zambezi regions, as well as Karas region from 2017 onward. Since 2016, I-TECH has also supported demand creation with a network of community-based mobilizers and recruiters using a human-centered design approach to actively engage communities and stakeholders to increase the number of men voluntarily electing medical circumcision. The program has performed over 36,000 VMMCs in Namibia.

I-TECH has trained physicians, nurses, and community counselors to ensure that adequate skills and experience are in place to deliver safe, high-quality male circumcision services.

VMMC Community Mobilizers Now More Mobile in Malawi

Adyasi Bamusi (left) receives advice on bicycle care from Lilongwe District Environmental Health Officer Mavuto Thomas.

Community Mobilizer Adyasi Bamusi (left) receives advice on bicycle care from Lilongwe District Environmental Health Officer Mavuto Thomas.

A group of eight Voluntary Medical Male Circumcision (VMMC) Community Mobilizers can breathe a sigh of relief after receiving bicycles to ease mobility in their clusters. The beneficiaries were selected based on the remote areas and long distances they cover.

Desiree Mhango, I-TECH Malawi’s Deputy Country Director, presented the bicycles. During the ceremony, Lilongwe District Environmental Health Officer Mavuto Thomas, thanked I-TECH for the donation of the 10 bicycles, saying they will be a huge help to mobilizers as they disseminate information on the importance of male circumcision.

Mr. Thomas further advised the eight beneficiaries to take good care of the bicycles in order to sustain their usefulness well into the future.

One of the beneficiaries, Adyasi Bamusi, said the bicycles will not only solve mobility problems in rural communities, but also will be used to ferry clients to circumcision centers.

I-TECH’s VMMC program, administered in partnership with the Lilongwe District Health Office, is funded by the Health Resources and Services Administration (HRSA) in collaboration with the U.S. Centers for Disease Control and Prevention’s Division of Global HIV and AIDS (CDC-DGHA), under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

The donation is part of a pilot study examining the impact of bicycles on the effectiveness of community mobilizers in rural areas.

Launch of HIV Programs in Zimbabwe Hits the Right Note


To the brass beats of the Prince Edward School Jazz Band, on Feb. 6, a crowd of approximately 150 government officials, health professionals, and members of the press celebrated the launch of three programs in Zimbabwe, two of which are implemented by I-TECH Zimbabwe and partners. These vital programs aim to build local capacity and provide comprehensive services to prevent and combat HIV/AIDS in the country.

Speaking at the festivities were David Bruce Wharton, U.S. Ambassador to the Republic of Zimbabwe; Dr. Owen Mugurungi, director of the AIDS and TB Unit at the Ministry of Health and Child Care (MOHCC); Dr. King Holmes, Chair of the Department of Global Health at the University of Washington; Dr. Ann Downer, Executive Director of the International Training and Education Center for Health (I-TECH); and Dr. Batsirai Makunike-Chikwinya, Country Director of I-TECH Zimbabwe.

“Preventing the spread of HIV/AIDS is important to all of us, as is providing the best level of care to those living with this disease,” said Amb. Wharton. “Today we celebrate the launch of programs that will help us reach these goals together – programs that were designed together, by dedicated teams of collaborating partners from Zimbabwe and from the United States.”

In this spirit of collaboration, the programs, totaling $65 million over five years, support the Zimbabwe MOHCC with grant funding by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), technical support from the Centers for Disease Control and Prevention, and implementation by local and U.S.-based partners. These partners include I-TECH; Zimbabwe Association of Church-Related Hospitals; Zimbabwe Community Health Intervention Research Project; Compre Health Services; The Newlands Clinic and Newlands Clinic Training Centre; Pangaea Global AIDS Foundation, Zimbabwe; and the University of Zimbabwe-University of California, San Francisco Collaborative Research Programme.

The Training and Mentoring Program seeks to develop and deliver in-service training on antiretroviral therapy, including the medical management of HIV/AIDS, women’s reproductive health, tuberculosis (TB), and TB/HIV co-infection to 8,000 health care workers across the country over five years. A mentorship component will also provide health care workers with access to ongoing learning and feedback on clinical issues. Health workers will receive refresher trainings via distance learning technologies, and the effectiveness of the program will be measured through a training database.

Also celebrated – and accompanied by a ribbon-cutting and presentation of 17 new vehicles – was the launch of the Voluntary Medical Male Circumcision Program. The program, building on work that started last spring, seeks to deliver services to 412,000 men in Zimbabwe between the ages of 15 and 49 years over the next five years. Medical male circumcision has proved very effective in preventing the spread of HIV. Randomized controlled trials in Uganda, Kenya, and South Africa have shown that this intervention reduces the risk of female-to-male sexual transmission of HIV by approximately 60%.

“Together, these two programs will improve the effectiveness and quality of prevention, treatment, and care services for those affected by HIV/AIDS – and create better health systems for all Zimbabweans,” said Dr. Holmes.

Malawi Bishop Promotes Male Circumcision

Right Reverend Bishop Emmanuel Fanuel Magangani of the Anglican Diocese of Northern Malawi is the first prominent church leader to  announce that he was recently circumcised as part of the country’s efforts to promote Voluntary Medical Male Circumcision (VMMC).

I-TECH’s Pius Mtike (PM) sat down with Bishop Magangani (BM) to find out more about the bishop’s experience with VMMC and why he decided to go public about this personal matter.

bishopPM: Bwaila is one of the dedicated VMMC sites in Malawi that opened in September 2012.  You are one the 6,205 males who have been medically circumcised there. What led you to make the decision?

BM: I have done it for the sake of the people I serve.

PM: What do you mean?

BM: Although I am not speaking in the official position of Anglican Church in Malawi, I remain convinced that my personal experience of VMMC will help to serve some lives of those who are still contemplating whether or not to access VMMC service.

To begin with, the Church is responsible for the body and soul of a human being. HIV and AIDS scourge is undoubtedly one of the difficult battles of our time. This fight involves the entire community with the Church at its center.

The leadership of the Church must take a lead on health related issues because bodily life and health are goods entrusted to man by God. Accordingly, there is an obligation to take care of one’s health.

HIV and AIDS continues to take many lives; we must try every possible way available to fight reduce further transmission.  The role male circumcision in HIV prevention just shows that science is in agreement with the word of God. You remember in Genesis 17: God commanded Abraham while he was in his old age to go for circumcision to enter into a special covenant with God. Whatever God did, he used to say: It is good. We too should promote what is good in the sight of God.

I must hasten to emphasize that circumcision has nothing to do with salvation. It is only Jesus Christ who serves. MC must be encouraged because God recommended it. It is good in his sight. It is also good for our own health and safety

PM: As someone who is championing medical male circumcision, how does VMMC help to reduce HIV infection?

BM: Health workers are more competent to explain that, but before accessing my VMMC services, I was counselled that the inside of the foreskin is soft and moist and is more likely to get a tiny tear or sore that allows HIV to enter the body more easily. The foreskin itself contains many “target cells” that allow HIV to enter the body easily. After circumcision, the skin on the head of the penis becomes thicker and is less likely to tear. A circumcised man is up to 60 percent less likely to get HIV than an uncircumcised man. MC also benefits women by reducing their chance of suffering from cervical cancer.

PM: After accessing VMMC services, what are you telling your congregation about circumcision?

BM: Circumcision is not a new concept. It has biblical foundation. Even God commanded Abraham to go for circumcision. Life is all about choices. The Bible urges us to make wise decisions and good choices; getting circumcised at a hospital is wise decision.

Let me emphasize that circumcision only reduces a man’s chances of contracting HIV. It does not protect him completely. Within marriage, both partners must know their HIV status, and both must remain faithful to each other or use condoms.

PM: Some men are interested to access VMMC services but have fears such as pain. Can you share your personal experience?

BM: Yes. (He laughed)

The operation is simple and safe. It took me only 20 minutes. They gave me an injection which took away pain. When the clinical officer told me that he had finished, I was really surprised. I did not feel pain.  I was able to do my work normally.

PM:  In your opinion what practical steps can the Church and other leaders take to help advocate for VMMC within their communities?

BM: There are many steps:

• Dedicate prayers and sermons specifically to VMMC and HIV and AIDS prevention.

• Use religious meetings like weddings, initiations, festivals, church meetings and youth retreats etc.

• Discuss male circumcisions in groups like church elders and mothers’ unions.


More on VMMC in Malawi

The results of randomized scientific trials conducted in three countries—namely Kenya at Kisumu, Uganda at Rakai, and South Africa at Orange Farm—demonstrate compelling evidence that VMMC, a one-time health intervention, provides life-long partial protection against HIV and other sexually transmitted infections. Studies show that the procedure reduces the risk of female-to-male sexual transmission of HIV by approximately 60 percent.

In 2007, the World Health Organization (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) issued recommendations to implement VMMC in settings with high HIV prevalence and low prevalence of male circumcision. WHO and UNAIDS identified 13 priority countries for scale up of VMMC. These countries are: Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, Tanzania, Zambia, and Zimbabwe. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) is supporting activities to implement VMMC in these 13 countries and also in Ethiopia, making a total of 14 priority countries.

Malawi launched a National Policy on VMMC in October 2012, which guides the implementation of VMMC programs in the country.

Malawi’s Nkhoma Hospital Launches Voluntary Medical Male Circumcision Program

Report by Pius Mtike

Lilongwe District’s Nkhoma Hospital has started offering Voluntary Medical Male Circumcision (VMMC) services.

VMMC services began with great enthusiasm: 37 procedures were performed in less than two weeks, according to Dr. Roderick Banda, Medical Officer at Nkhoma Hospital.

“We are encouraged by this overwhelming response,” Banda said.

Malawi comediansThe project has taken a novel approach to recruiting participants by staging a two-week awareness campaign that incorporates comedy, music, and film. The group has engaged the services of popular local comedians Chindime and Samalani and the Health Education Band of the Ministry of Health. VMMC promotional film documentaries will also be shown.

Local leaders are also getting in on the act. Encouraging his subjects following a VMMC promotional documentary, Group Village Headman (GVH) Chimwaye underscored the need to seriously consider VMMC, a one-time intervention scientifically proven to reduce the transmission of HIV by 60 percent.

“Now we have no reason to complain about long distance to town (VMMC Center in old town in Lilongwe),” he said. “VMMC services are within our own vicinity.”

The initiative is in partnership with Lilongwe District Office and Health Education Unit of the Ministry of Health (HEU), and the International Technology and Education Centers for Health (I-TECH) Malawi as part of a PEPFAR subgrant. It is intended to encourage more eligible men to access locally available VMMC services.