Circumcision, soccer and HIV prevention in Swaziland

Persuading men and boys to get circumcised is no easy task.

On top of fears about pain, it’s an uncommon, stigmatized procedure in this small African country of about 1.2 million people.

But the health benefits are clear – and not just for men. For both sexes, male circumcision reduces the risk of certain reproductive cancers and helps prevent the spread of HIV and genital HPV.

For men, studies have shown, circumcision lowers the risk of HIV infection by about 60 percent.

“It’s a very minor procedure,” says Pact’s Thobile Mkhonta, “but the benefits are huge.”

That’s why Pact, in partnership with local NGOs, is working to increase circumcision rates among men and boys in Swaziland. Last summer, Pact began educating communities about the advantages of circumcision, allaying fears that are based mostly on misconceptions.

In schools, Pact starts by giving information to teachers, and then it does the same with groups of boys and parents.

But to make a real impact, Mkhonta says, “We have to be creative.”

That’s where soccer comes in.

In every constituency in Swaziland, there are chiefdoms, and in every chiefdom, there are a handful of public soccer teams. In November, Pact launched a competition challenging all of the teams in Ntfonjeni constituency to refer as many men and boys for circumcision as possible by late March. Pact tracked results using referral cards, with a different color card for each team. Winners from each chiefdom are advancing to a Pact-sponsored soccer tournament this month. 

“It’s a great way to get all kinds of people involved who we might not normally reach,” says Ncamsile Tfwala, a program manager in Pact’s Swaziland office.

Pact is also boosting referrals with incentives for schools. Each school is given a target for 70 percent of eligible boys to be circumcised, and when targets are met, schools receive rewards such as sports equipment and supplies.

Pact also hosts educational public events with games and entertainment to spread the word about circumcision’s benefits, and it trains volunteer community recruiters who go door to door to follow up with consent forms for families who’ve attended information sessions.

“We often find the boys want to be involved, but their parents are hesitant,” Tfwala says.

In the program’s first six months, Pact’s efforts led to 780 circumcisions, with a goal of thousands more as work continues.

Men and boys who choose to have the procedure are referred to the Centre for HIV and AIDS Prevention Studies, or CHAPS, a South African NGO that is partnering with Pact and recently began working in Swaziland.

The program is funded by the U.S. Agency for International Development.

As more men and boys are circumcised, they’re spreading the word to others that the procedure is easier than they thought.

“We’ve found that hearing directly from someone who has done it helps to put boys who are considering circumcision at ease,” Mkhonta says. “We’re trying various approaches and tracking what is most successful.”

Pact’s next steps include expanding the program to new geographic areas using data-driven best practices, as well as building the capacity of local NGOs to carry out such work.