For many years, Kishiwa Shiku, a resident of Tabora Region in Tanzania, firmly believed that male circumcision was a harmful practice that could lead to impotence and reduce a man’s sexual vitality. This belief was shaped by the traditions of his community, where circumcision was not a common practice. However, Kishiwa didn’t know that male circumcision could significantly reduce the risk of contracting sexually transmitted infections, including HIV, by up to 60 percent.
“I never heard about the health benefits of circumcision during my youth. I only came to understand its importance when I met the health educator in our community, who helped me see the truth,” Kishiwa said.
Paulo Michael, a dedicated volunteer community advocate (VCA), was instrumental in transforming Kishiwa’s understanding of voluntary medical male circumcision (VMMC). With support from the U.S. President’s Emergency Plan for AIDS Relief through the U.S. Agency for International Development, the Reaching Impact, Saturation, and Epidemic Control (RISE)-Tanzania project engages VCAs such as Paulo Michael to conduct community-based outreaches providing crucial health education and VMMC services to underserved and remote communities across five regions in Tanzania, including Tabora. RISE works in close collaboration with the Tanzania Ministry of Health (MOH) at the national, regional, and local level to support Tanzania’s HIV prevention priorities, including sustainable, MOH-led integrated VMMC and HIV prevention services.
Through the RISE-Tanzania VMMC project, Paulo collaborates closely with the Tabora Regional Health Management Team to deliver health education and HIV prevention services to rural areas. His unwavering dedication to reaching remote villages has been essential in raising awareness about the health benefits of VMMC, helping to dispel myths and encourage positive change in these hard-to-reach areas.
On a good day, I can reach up to 40 families, and if everything goes smoothly, 30 young men may decide to receive the service. It fills me with pride to know I am contributing to the health and well-being of my community.”
Paulo Micheal
Led by Jhpiego, the RISE project has equipped Paulo with an understanding of how VMMC improves personal hygiene and also reduces a man’s risk of acquiring HIV and other sexually transmitted infections. Importantly, circumcision also plays a vital role in protecting women: women whose male partner are circumcised are less likely to develop cervical cancer, which is caused by the human papilloma virus. Women are also indirectly protected from HIV; if a man never acquires HIV, he cannot transmit the virus. Through his dedication, Paulo has become a trusted and respected figure in his community, as he continues to educate others about the importance of VMMC in preventing HIV and promoting overall health.
After his circumcision, Kishiwa encouraged his grandson and youngest son to be circumcised through RISE supported services. Grateful for the knowledge he gained from Paulo, he now understands the importance of passing on this crucial information to others in his community. Determined to share the benefits of circumcision, Kishiwa is committed to educating those around him, helping to spread awareness and improve health outcomes in his village
“The misconceptions about circumcision have certainly cost us,” Kishiwa reflects. “Even when I started to understand the truth, I was still hesitant and afraid of the procedure. For years, I avoided it. But Paulo, our health educator, was able to convince me and showed me the importance of it.”
The RISE-Tanzania VMMC project is not only increasing awareness about male circumcision but is also improving access to other essential HIV prevention, care, and treatment services. By focusing on integrated, age- and population-specific activities, the project has strengthened linkages for individuals who test HIV positive, connecting them to care and treatment centers. This holistic approach is making a significant impact on prevention efforts and access to care for those living with HIV.
As of September 2024, RISE-Tanzania, in partnership with Government of Tanzania health care workers, has provided VMMC to 198,400 clients aged 15 and older. The project has also mobilized 734 VCAs and 1,010 local leaders and influencers and has trained more than 340 health care providers to facilitate access to circumcision services since its inception in 2022. While RISE-Tanzania works in a broad range of communities across the five supported regions in Tanzania, the greatest demand for VMMC services continues to be in remote areas where health facilities are limited and many local clinics do not meet the MOH’s criteria to function as independent VMMC sites. Addressing these gaps and integrating VMMC into the MOH’s routine, primary health care services remain a key priority in expanding access to this and other essential health services.
Kishiwa’s journey from skepticism to acceptance highlights the transformative impact of the project, which continues to empower individuals, educate communities, and contribute to the MOH’s health priorities across Tanzania. Through this collaborative effort, RISE is not only changing individual lives but is also contributing to the broader goal of reducing HIV/AIDS and enhancing the overall well-being of Tanzanians.
Paulo’s dedication and Kishiwa’s transformation highlight the significant progress being made in integrated, sustainable HIV prevention and primary care services in Tanzania, demonstrating the power of knowledge and community-based advocacy in improving health outcomes.