Tiffany Miller
Christmas Shikongo is a 33-year-old father of three and a community mobilser working to reduce HIV-related deaths in Omuhongo village, northern Namibia.
For months, he has been educating and counselling adolescent boys, men, and their partners on the health benefits of voluntary medical male circumcision (VMMC) in preventing HIV. As he escorted some of his community members to undergo the procedure, he carried a secret: fear and uncertainty made him keep silent about his own uncircumcised status.
Shikongo knew all the right reasons to have the procedure, which he learned during a mobiliser training. “When I joined the training, it was about making a living, getting money to put food on the table for my partner and children. But as time went on, I started feeling like I was living a lie. Here I was, educating young boys and men to take up the service while I was not circumcised myself,” tells Shikongo.
As a community mobiliser, he knew what was at stake. Research has demonstrated the effectiveness of VMMC in reducing the risk of female-to-male sexual transmission of HIV by up to 60%, compared to uncircumcised men. When used in combination with other measures, such as the use of condoms, or a reduction in the number of partners, VMMC is an important addition to men’s HIV prevention options. It also has significant health benefits for women, such as lowering the risk of getting cervical cancer.
This is why the Namibian Ministry of Health and Social Services (MOHSS) has made VMMC a key intervention of the country’s HIV prevention strategy. The ministry partnered with the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) and their implementing partner Abt Associates to train mobilisers who promote the health benefits of VMMC in their communities.
When Shikongo opened up to his partner, Maria, about the guilt he was feeling and his fear of going for the Smart Cut (circumcision), he slowly changed his mind. Recognising his concerns, Maria asked him to educate her about the procedure. He happily shared the benefits of male circumcision for both men and women with her, and explained that as part of a comprehensive package of health services offered along with VMMC, men receive HIV testing and counseling services, guidance on condom use, and screening for sexually transmitted infections. In addition, women with circumcised partners face a lower risk of developing cervical cancer, a leading killer of women in Namibia.
Once Maria felt well-informed about VMMC, she spoke to her female friends in the community about it. They also started sharing the information, and increasingly managed to convince their partners of the advantages of being circumcised. “They told me about how much closer they were with their partners, and how their relationships got stronger, and hygiene improved since their partners and husbands got circumcised,” she said.
These stories shared with Shikongo convinced him to finally get circumcised. “Maria told me, ‘You are smart. You must go to the clinic and get the Smart Cut.’ I couldn’t put it off any longer. I knew it was time for me to let go of my fear and shame,” he recounted.
After the 45-minute procedure, Shikongo was notably relieved. “Now that I am circumcised, it’s so much easier to explain the process and answer questions related to circumcision. It is no longer just about making money; I’m now a proud circumcised mobiliser who feels confident when educating my community,” he said.
Elise Nghishoongele has a similar story to tell. The 20-year-old student at the University of Namibia’s campus in Eenhana near Namibia’s northern border with Angola learned about circumcision when a VMMC team conducted a health education session on campus. Although she was initially hesitant to attend, today she’s glad she did.
“When I saw the poster about VMMC inviting both males and females to a health information session, I was hesitant to go – wondering why I should attend a session meant for men; what could I possibly gain from it?” she remembered.
During the discussions, she was not only reminded of the procedure’s advantages for men but, most importantly, also for her as the female partner. She passed on the information to her boyfriend Johannes Nepolo, 28, the same day.
“I was a bit scared to bring up the topic because we have never spoken about it, and I didn’t know how he would react,” Nghishoongele said. Nonetheless, she told him about the benefits of VMMC for both men and women. Despite his general open-mindedness, it was not easy to convince Nepolo to get the Smart Cut.
“Growing up, I had the opportunity to be circumcised on many occasions, but I always ran away from it because I feared the pain,” he stated.
Nghishoongele continued to encourage him. After several discussions, she accompanied him to the VMMC clinic, where the VMMC coordinator explained the procedure to him in detail. The process only takes 45 minutes, local anesthesia is used to numb the area before the cut, and pain relief is provided after the procedure in case it is needed.
“Before I knew it, I booked myself for the procedure. My beautiful and loving girlfriend escorted me to the clinic the next day. She waited for me while I was circumcised, and supported me throughout the recovery process. And, contrary to my fear, I experienced no pain during the procedure,” said Nepolo proudly.
He was discharged, and went home right after the procedure. Two days later, he returned with Nghishoongele by his side for a scheduled post-operative assessment and wound care. He recovered quickly, and returned to work promptly. “My partner and I are more intimate and living healthier now. Gents, man up and get circumcised, it is quick, easy and free,” he added.
Partners like Maria and Nghishoongele, mothers, and other women have become allies in preventing HIV and lowering the risk of developing cervical cancer by encouraging their partners to get the Smart Cut.
* Tiffany Miller is the U.S. Embassy’s public affairs officer and spokesperson.