By Shannon Hader and Elizabeth Mallas
As we prepare for the 2012 International AIDS Conference this month, many are reflecting on the successes and challenges we are facing in the fight against HIV. As Americans, we can be proud that the United States is taking a leadership role in supporting countries around the world who are fighting to save the lives of their countrymen and women.
In Swaziland, a country that has been heavily impacted by HIV, the Government of the Kingdom of Swaziland is using all of the available tools in their toolbox to save lives. Last year in response to new scientific evidence, the Government of the Kingdom of Swaziland embraced male circumcision as an HIV prevention strategy. This new evidence showed that voluntary medical male circumcision can reduce the rate of HIV transmission by up to 60%.
From the Swazi Government's commitment, the country's male circumcision Accelerated Saturation Initiative was born. It was an unprecedented effort to roll out voluntary medical male circumcision for HIV prevention to achieve rapid coverage at a national level.
Futures Group was pleased to have had the opportunity to implement the initiative on behalf of the Government of the Kingdom Swaziland and the U.S. Government. There were many partners involved in the program, all of whom worked with dedication to slow the spread of HIV and save lives.
A major scale up of adult voluntary medical male circumcision had never been attempted with a national population or in this short a timeframe – by any partner. It was untested ground, and the two governments and their implementing partners did it because lives were at stake.
According to UNAIDS, an estimated 14,000 adults and children were newly infected with HIV in Swaziland in 2009. A recent study led by the Swaziland Ministry of Health found that national prevalence of HIV is 31% among adults ages 18-49, and current prevalence peaks at 54% for women ages 30-34 and at 48% for men ages 35-39.
The Accelerated Saturation Initiative made significant inroads in introducing an innovative HIV prevention program to Swaziland. With funding from USAID, and building on early support from the Bill & Melinda Gates Foundation, project partners trained more than 200 clinicians and nine trainers. In-depth advocacy campaigns took place on male circumcision and HIV prevention with royalty, traditional leaders, healers, unions, businesses, religious groups, and government.
While there were successes, the program was not without challenges. In fact, all male circumcision programs have faced challenges. Despite the HIV prevention benefits, for many men the decision to be circumcised is not a rapid one. At the end of the day, heavily affected countries continue to raise awareness of male circumcision and continue to offer this HIV prevention service because the world knows it is effective – and because we are committed to saving lives.
Shannon Hader is a Vice President and Director of Futures Group’s Center for Health Systems and Solutions. Elizabeth Mallas is Deputy Director of Futures Group’s Center for Health Systems and Solutions.