Approximately 330 128 men are expected to be circumcised by the end of 2015/16 financial year (FY) in Namibia as underlined in the National Strategic Framework for HIV/Aids response 2010/11-2015/16.
The strategic framework and implementation plan launched in February by the Minister of Health and Social Services (MoHSS), Dr Richard Kamwi, is expected to bring Namibia amongst a group of countries prioritising Voluntary Medical Male Circumcision (VMMC) as a part of an effective HIV response.
Dr Kamwi says the goal of the strategy is to ensure free, safe and accessible voluntary medical male circumcision to men, boys and newborn male children without discrimination.
The service will be provided according to the highest standards and adhere to medical ethics, with full observance to human rights and confidentiality.
“Male circumcision should be provided on the basis that it is part of a comprehensive HIV prevention strategy and should be integrated into other HIV and sexual and reproductive health services,” he says.
The strategy was initiated after the recommendations of the World Health Organisation (WHO) and United Nations Program on AIDS (UNAIDS) made in 2007, to include circumcision among HIV prevention strategies.
As a result, many countries in the Southern African region have taken steps to establish and strengthen their voluntary male circumcision services as part of efforts to combat the deadly disease.
Several surveys run under WHO and UNAIDS in countries such as Kenya, South Africa and Uganda, have shown evidence that male circumcision (MC) reduce the risk of HIV infection among men by 60-70%.
The scientific studies further show evidence that women also benefit from the exercise through the reduction in their acquisition of several sexually transmissible infections, including herpes simplex virus type-2 (HSV-2), syphilis and cervical cancers, amongst others.
MoHSS implemented this plan in 2009 as a VMMC pilot project in selected regions of Namibia where the results revealed the regions with low male circumcision rates had higher HIV prevalence rates. The permanent secretary, Andrew Ndishishi, says the initial stage of the pilot is already being carried out in four health facilities; Windhoek Central Hospital, Oshakati Intermediate Referral Hospital, Onandjokwe Lutheran Mission Hospital and the Military Hospital in Grootfontein. MC services had also been extended to more health facilities in 2010 with 1987 men circumcised.
Following the results of the VMMC pilot and to expand its services throughout the country, MoHSS has since further led a national technical working group to develop a sound, evidence-based strategy.
The Namibian National Strategic Plan 2010/11-2015/16 was drawn up and revised in 2013, identifying medical male circumcision as one of the six core programmes to prevent and control the spread of HIV in the country.
“The lesson learnt from countries in the sub-Saharan region that implement MC for HIV prevention as well as recommendation from WHO on models for optimising volume and efficiency for male circumcision services have informed the approach recommended in this strategy,” Dr Kamwi says.
MoHSS public relations officer (PRO), Ester Paulus says the VMMC will change the landscape of HIV/Aids in Namibia for the better: “Male circumcision is a one-time, low cost medical intervention, which has been recommended by the WHO as part of a comprehensive package of HIV prevention.”
According to the strategic plan, the immediate priority of the strategy is to reach adult men who are most at risk of HIV exposure during heterosexual intercourse, as well as initiating services for adolescents. The 15- 49 year age group was identified as most vulnerable, therefore, the primary target group for MC comprises of HIV negative boys and men who fall in this age bracket.
The total estimated implementation plan is expected to cost N$202m over a three-year period, before providing for a five percent contingency.
The plan states the most expensive outcome relating to the provision of adult medical male circumcision (OC19) is estimated to cost N$192.8m, with the first two years accounting for an estimate of N$85.5m.
The MC communication budget comprises N$8.2m over a period of three years.
For the funding, MoHSS spokesperson says the US President’s Emergency Plan for Aids Relief (PEPFAR) has provided both technical and financial support to Namibia, in particular, the MoHSS and its partners in developing the strategy and implementation plan.
PEPFAR, in collaboration with the MoHSS, will further support the scaling up of VMMC in two regions of Namibia. These will be the Oshana and the Zambezi regions, over the next three years while the Global Fund to fight Aids, TB and Malaria will support the expansion of VMMC in five regions of Namibia; Khomas, Omusati, Kavango East and West, Ohangwena and Oshikoto.