Schools, soccer, and the streets: innovative demand creation for VMMC in Zimbabwe

Street performers engage young men as part of CDC’s VMMC demand creation efforts.

In Chitungwiza district, just outside Zimbabwe’s capital of Harare, a growing crowd of men, women, and children gather to watch a group of street performers. While the group sways together to the captivating reggae beat – clapping, singing, and laughing along with the performance – community mobilizers quietly move throughout the crowd distributing information about voluntary medical male circumcision (VMMC) to men and boys. Thanks to CDC, its implementing partners, and the Ministry of Health and Child Care (MoHCC) in Zimbabwe, these men can walk just across the street to the Seke North Clinic to receive additional information and counseling about VMMC and even have the procedure performed if desired.

According to extensive scientific research, VMMC reduces a man’s risk of acquiring HIV through heterosexual exposure by 60 percent; as such, it is a key strategy for HIV prevention in high-prevalence countries like Zimbabwe. Through the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR), and in close collaboration with MoHCC, CDC is implementing VMMC activities through a consortium (titled ZAZIC) which includes the International Training and Education Center for Health (ITECH) and two local Zimbabwean implementing partners: the Zimbabwe Association of Church-related Hospitals (ZACH) and the Zimbabwe Community Health Research Intervention Project (ZiCHIRe).

MoHCC and its partners supported the voluntary circumcision of 1,059,970 Zimbabwean men between January 2009 and August 2017, which translates into more than 80% of the national prevention target of 1.3 million circumcisions among men aged 13 to 29. A number of strategies, detailed below, have contributed to this achievement.

Street Performances

Street performances are an attractive venue for community education. These performances are scheduled during times and locations where males are most likely to congregate, including barber shops, entertainment establishments, and weekend sporting events. Through skits, street performers correct common myths, provide accurate information, and position VMMC as a lifestyle choice inspiring self-confidence and self-esteem.

School Outreach

During school breaks, ZAZIC and other partners conduct VMMC campaigns which include HIV testing and counseling services, information about HIV prevention, and post-circumcision care. CDC and ZAZIC have built relationships with school leaders and provide incentives for students such as school supplies and soccer equipment, while strengthening the school health curriculum on prevention of sexually transmitted infections including HIV.

Soccer Galas

Demand creation in rural areas has greatly benefited from VMMC soccer galas, targeting out-of-school youths. The program has seen huge numbers (up to 100 per day) being circumcised during these galas, particularly among young men in the most critical age group (15 to 29).

Community collaboration

The consortium also collaborates with the VaRemba (a traditionally circumcising community in Zimbabwe) by providing VMMC service delivery during communities’ rites of passage camping activities. More than 1,000 boys and young men received voluntary medical male circumcision during the last rites-of-passage camping season in Mberengwa district.

In addition to Zimbabwe, CDC is working to increase impact through partnerships across 11 other high-burden African countries to scale up VMMC for HIV prevention. To date, CDC supported VMMCs for 7.5 million men in Southern and Eastern Africa – nearly half of all PEPFAR-supported procedures worldwide.