With just over one year left to achieve its target of having some 1.1 million men circumcised as part of HIV-prevention efforts, Kenyan male circumcision programmes are ramping up efforts to bring more men into clinics, compensating them for their time and encouraging them to bring friends in for the procedure.
Some medical male circumcision programmes are piloting the use of vouchers, giving men coupons worth 100 Kenya shillings (about US$1.17) when they complete the procedure; these vouchers are redeemable for cash once the man returns for a follow-up visit. The men are encouraged to return with a friend or relative also wishing to be circumcised.
"Compensation for time lost to such persons has seen many of them turn up in large numbers to get circumcised," Walter Obiero, the clinical manager at the Nyanza Reproductive Health Society, told IRIN/ PlusNews.
Loss of income is a reason frequently cited by men rejecting circumcision, many of whom wrongly believe they will be unable to work during the entire six-week healing period. In fact, men can usually return to work within three or four days.
Most efforts to increase voluntary male medical circumcision (VMMC) have been focused in the western province of Nyanza, which is dominated by the traditionally non-circumcising Luo community. The programme has also been rolled out in the capital, Nairobi, and the northwestern Turkana region, where circumcision levels are low.
"We have focused on other regions as well so that we can have as many people as possible getting medically circumcised," Obiero said.
Kenya has carried out an estimated 477,000 circumcisions since the programme started in 2008, according to the government. "This figure does not include those in the private sector where voluntary medical male circumcision is also done," said Obiero.
Male circumcision has been scientifically proven to reduce a man's risk of contracting HIV through vaginal intercourse by as much as 60 percent. Follow-up studies have found that the effectiveness of male circumcision for HIV prevention is maintained for several years.
In 2011, UNAIDS and the US President's Emergency Plan for AIDS Relief (PEPFAR) launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015.
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"To ensure that we achieve our target, the government will increase sensitization and mobilization efforts to ensure we can have more people embrace male circumcision as an HIV prevention method," Athanasius Ochieng, VMMC programme manager at the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), told IRIN/PlusNews.
The role of women will also need to be increased. "It will also be critical to engage women in mobilization of their partners and to ensure that they play a bigger role in VMMC than is done currently," Mark Okundi, a communication specialist with US-funded AIDS Population and Health Integrated Assistance, said.
Casting a wider net
The government is considering integrating male circumcision, currently offered as part of its HIV prevention package, into outpatient services in public hospitals, as well as starting infant male circumcision, which studies have found to be cost-effective. A recent study carried out among 1,200 infants in Nyanza Province concluded that infant male circumcision was safe, and an earlier study concluded that it was acceptable to most parents.
"We are carrying out studies on infant male circumcision, and once we have this, then we will find out the possibility of rolling out nationally," Ochieng said.
Currently, the programme focuses on males aged 15 and above, though private hospitals do carry out the procedure on infants at parents' request.
The national male circumcision programme holds an annual Rapid Results Initiative (RRI) every November and December, which boosts circumcision numbers significantly through mobile clinics and ramped up publicity. The RRI suffered a setback in 2011, however, meeting just over half the target of 70,000 men due to heavy rains that made many roads in Nyanza impassable.