At two workshops held with the Department of Justice and Correctional Services (DJCS) in August, TB/HIV Care Association was able to report on several improvements in TB and HIV care in the Pollsmoor Management Area.

Any successes have been made possible by the close partnership between the stakeholders involved in providing TB and HIV care in correctional services. Many of these partners were present at the workshops which took place in the Western and Eastern Cape and included the National and Regional Department of Justice and Correctional Services (DJCS), who hosted the workshops, the Departments of Health (DOH) (Western and Eastern Cape), the Hospice Palliative Care Association, the National Health Laboratory Systems, Right to Care, SA Partners and Sonke Gender Justice.

The aim of the workshops was to solidify these partnerships and chart a way forward. The objectives therefore included informing all participants of donor-funded project activities in TB and HIV care, working on operational plans to strengthen TB and HIV health care service provision in correctional services settings and the clarification of the roles and responsibilities of all the stakeholders.

Formal presentations were done by the heads of the DOH and DJCS from national and provincial levels and thereafter breakaway group discussions took place around several focus areas. Each group created plans on how to address challenges within their area of expertise and team members were identified to take the lead in the implementation of these plans.

What is the relationship between TB/HIV Care Association and the Department of Health in terms of medical male circumcision?

Medical male circumcision (MMC) is part of a national campaign driven by the Department of Health in all provinces and launched by the National Minister of Health, Dr Aaron Motsoaledi. Naturally, all provinces are included in this national campaign so as to ensure that the benefits of HIV prevention can also be felt throughout the country. In order to help meet the ambitious targets of the national campaign, that of circumcising a million males by 2015 and 4 million by 2016, the Department of Health has formed agreements with nongovernmental organisations to help provide the service. TB/HIV Care Association has a memorandum of understanding with the Department of Health to provide MMC services in the Western Cape’s Metro, West Coast District and Central Karoo District; the OR Tambo, Alfred Nzo, Buffalo City Municipality and Nelson Mandela Bay Municipality in the Eastern Cape; and Harry Gwala District in KwaZulu-Natal.

Is medical male circumcision safe?

Any surgical procedure carries risks, and medical male circumcision is a minor surgical procedure. However, because the procedure is conducted with sterile equipment by qualified personnel and follow up care is provided, the risk of any adverse event is extremely low. If you experience excessive bleeding or pain or are concerned in any way, you should contact your service provider, a clinic or doctor immediately.

Is medical male circumcision painful?

The procedure is done under a local anesthetic so you will not feel it. After the procedure, when the anesthetic wears off, you may experience some pain, but the nurse or doctor who performs the procedure will provide you with painkillers to help you deal with this.

How is medical male circumcision different to other kinds of circumcision?

MMC is different to other kinds of circumcision in three main ways.

Firstly, because of the way in which MMC is performed, you can be sure that you will receive the benefits of a reduced risk of HIV. The way other kinds of circumcisions are performed varies quite a lot, which means that you MAY be left with part of your foreskin and in that case, would not receive the benefits in terms of HIV and STI risk reduction.

Secondly, medical male circumcisions are always performed with sterile equipment by qualified medical personnel.

Thirdly, in general MMC does not have the cultural traditions attached to it, which some other kinds of circumcisions do. Some kinds of circumcision are linked with tradition or religion and have great social significance to those who undergo them. We respect this and people’s right to choose how they wish to honour their tradition.

What are the benefits of medical male circumcision? Why should I have this done?

• An MMC reduces the risk of an HIV negative male contracting HIV by 60%
• reduced risk of cervical cancer for female partner
• reduced risk of sexually-transmitted infections
• makes the penis easier to clean

Who can have medical male circumcision?

The age of males targeted by this national campaign is 15-49, however, under the Children’s Act 2005 no 38, section 12(8), males under 18 can be circumcised with the consent of a parent, guardian or caregiver and children under 16 can be circumcised for a medical reason (such as HIV prevention) with the consent of a parent, guardian or caregiver.

How much does it cost?

The procedure is free. All procedures are done in a safe, clinical environment.

How long does it take?

The actual procedure takes 30 minutes or less.

Will a medical male circumcision protect my partner from HIV?

No, if you become infected with HIV, you will pass it on to your partner unless you use a condom.

Do I still need to use a condom if I’ve had a medical male circumcision?

Yes! Whether you have had an MMC or not, you need to wear a condom when you have sex. The MMC will reduce your risk of contracting HIV, but it will not eliminate it. You are still at risk if you do not wear a condom.

March, the month that includes World TB Day on the 24th of March, saw a TB/HIV Care team dressed in red overalls hit prisons around the country. TB/HIV Care had launched its part of the Kick TB/HIV campaign. By the end of the month, nearly 5000 inmates had been reached by the programme, which aims to raise awareness about TB and HIV.

Overcrowded and poorly ventilated spaces make prisons an ideal place for TB, an airborne disease, to be transmitted and HIV prevalence in prisons is high. The Global Fund has therefore committed several million Rand to the National Department of Health to efforts to control TB and HIV in correctional services and in peri-mining communities in South Africa, which has the highest incidence rate of TB cases in the world – 1003 per 100 000 people. One of the planned interventions is the roll-out of the Kick TB/HIV programme through several implementation partners, including TB/HIV Care Association.

The awareness sessions at the core of the Kick TB/HIV programme are based around the idea that active engagement promotes learning. The sessions are therefore ‘activations’ which use impromptu dancing competitions, music, an open dialogue and a kicking activity to convey messages about how to prevent or manage TB and HIV.

When given a chance to perform during the ‘open mike’ section of the programme, the inmates show off a range of talents including rapping, singing, dancing and beatboxing

The TB/HIV Care team visited Pollsmoor, Malmesbury, Goodwood and St Albans prisons repeatedly to be able to reach this large number of inmates. The prison setting is challenging, but the team persevered despite rain, blown speakers, a fight between inmates and a power failure.