Growing up in Kisumu County in the Nyanza region of Western Kenya, Silas Orwa, a 21-year-old student in Muhoroni, a sub-county in Kisumu, did not believe in circumcision. His community opposed the practice, believing “it was against traditions."
Although male circumcision was not a common practice in Silas’s community, 2006 trials conducted in Uganda and Kenya found that male circumcision reduced the risk of HIV acquisition among heterosexual men by 50 to 60 percent. Based on this evidence, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended in 2007 that voluntary medical male circumcision (VMMC) be offered as part of a comprehensive HIV prevention package in regions and countries with high HIV prevalence and low male circumcision rates, such as Kisumu County. Since then, more than 32 million men have undergone VMMC in Eastern and Southern Africa.
With guidance from the government of Kenya, the PATH Kenya–led United States Agency for International Development (USAID) Nuru Ya Mtoto project and its partners are rolling out VMMC services in Kisumu County as part of a comprehensive package to address the county’s high HIV burden. Part of USAID Nuru Ya Mtoto’s strategy is to increase access to free VMMC in project-supported health facilities, reflecting a region-specific approach to mitigating the impact of HIV.
The project also offers VMMC in combination with other services, reaching men with a highly effective package of HIV prevention services, including HIV testing, pre-exposure prophylaxis, and condom distribution. This comprehensive approach not only contributes to the reduction of HIV transmission but also aligns with Kenya's commitment to achieving the UNAIDS 95-95-95 targets. It embodies collaborative efforts to combat the HIV epidemic and advance the health and well-being of the community.
The USAID Nuru Ya Mtoto project equally works with community health promoters, who continuously conduct door-to-door outreach to provide personalized education, act as a liaison between community members and health care providers, and address individual concerns, fears, and misconceptions, thus helping men like Silas make informed decisions. Silas met one of the project’s community health promoters in his village.
“When I met one of the community health promoters during an outreach in my village, she did not just present facts; she shared stories of individuals like me who chose a healthier future despite cultural reservations.”— Silas Orwa, a resident in Muhoroni, has embraced VMMC.
From that point, Silas was convinced and went to the Muhoroni Sugar Company (MUSCO) health center in Muhoroni for VMMC services. Silas highlights the importance of knowledge in decision-making.
“[Before this encounter and life-changing moment,] I had googled a lot on VMMC, and I wanted to know the benefits. To me it was not just about reducing HIV risk; it was about reclaiming control over my health.”— Silas Orwa, a resident in Muhoroni, has embraced VMMC.
Since October 2022, USAID Nuru Ya Mtoto has provided VMMC services to more than 2,912 boys and men in Muhoroni, with the goal of helping to decrease the spread of HIV and save lives. USAID Nuru Ya Mtoto remains committed to increasing access to VMMC services through community outreach and in health care facilities. Recognizing the influential role of community leaders, the project also engages such individuals, working with them to dismantle traditional stigmas associated with the procedure. By doing so, USAID Nuru Ya Mtoto encourages a broader acceptance of VMMC as a proactive choice for a healthier future.
Despite progress, barriers persist. As in many communities in Kenya, significant cultural beliefs in Muhoroni continue to negatively impact the acceptance and uptake of VMMC. Muhoroni is a small rural area, well-known for sugarcane farming, having one of the largest sugar processing factories in the region. Most of its 145,764 residents are farmers, predominantly engaged in sugarcane cultivation as the main economic activity. Cultural norms continue to influence attitudes toward male circumcision within this population. USAID Nuru Ya Mtoto recognizes these norms as a barrier to VMMC uptake.
Masibo Wamalwa, technical advisor for USAID Nuru Ya Mtoto’s VMMC, key population, and fisherfolk focus areas, works closely with health providers in Muhoroni to increase access to VMMC services.
“As a service delivery project, we recognize the barriers that hinder VMMC uptake and implement impactful strategies, such as community engagement, education, [and] outreach, integrating VMMC with other services such as HIV to tackle the”— Masibo Wamalwa, technical advisor for USAID Nuru Ya Mtoto’s VMMC.
USAID Nuru Ya Mtoto also builds the capacity of community health promoters, enabling them to play a crucial role in fostering trust and promoting the acceptance of VMMC at the community level.
One of the community health promoters who has been trained by the project and understands the intricacies of his community's culture is 63-year-old Tom Awich. Tom has been working as a community health promoter in his community for decades and is well-known for his dedication to promoting health services. Tom believes that raising awareness of VMMC is the first step to addressing misconceptions about VMMC, which in turn significantly contributes to the well-being of the community. On a normal day, he carries his Job Aids, ready to visit households and promote the health benefits of VMMC.
“Cultural beliefs run deep here. Convincing individuals to consider VMMC requires a delicate balance between tradition and the proven health benefits [of circumcision].”— Tom Awich, Community Health Promoter.
Armed with knowledge and compassion, Tom journeys up to five kilometers a day, visiting households and imparting knowledge about the importance of VMMC. He equally addresses concerns that hinder access to these essential services, such as fear that circumcision entails severe pain and long healing periods, as well as, as well as the misconception that VMMC goes against cultural or religious beliefs.
Tom Awich, a community health promoter, is actively involved in promoting service uptake of VMMC at the Ogen Health Facility in Muhoroni as part of the USAID Nuru Ya Mtoto strategy to increase access to HIV prevention services. Photo: PATH/Denise Akun.
At the local health facility, Tom also engages young people in group discussions. He emphasizes the multifaceted advantages of VMMC, which range from promoting genital hygiene to reducing the incidence of sexually transmitted infections, including HIV. Tom is just one of the community health promoters in Muhoroni whose efforts significantly contribute to lowering HIV prevalence.
