TB HIV Care Voices: Reflecting back on our VMMC programme in OR Tambo

Staff blog. Submitted by Sithembiso Mabasa (Community Liaison Officer)

TB HIV Care (THC) started a VMMC programme in OR Tambo District in the Eastern Cape in 2012. Back then it was still taboo to even speak about medical male circumcision (MMC). The first time we kick-started the programme in Lusikisiki we (Zolani Barnes, Kwezi Shumi and Sithembiso Mabasa) were confronted by a group of traditional leaders who were so cross about the fact that we were introducing MMC. Threats were made then and even later THC staff members were often called names and verbally abused.

Through sheer resilience and determination THC stopped at nothing to bring this service to the individuals and communities of OR Tambo. Community mobilisation and demand creation activities were conducted in all corners of society (door-to-door campaigns, schools, community meetings and functions, churches, traditional imbizos, workplaces, national & provincial functions, bilaterals, taxi ranks, community radio stations, local newspapers, distribution of flyers, pamphlets, sport events etc). Excellent work has been done by our clinical team over the years, ensuring quality service (despite poor and often challenging conditions) and lives have been improved and saved.

Just this week we received numerous invitations from the Department of Education and Walter Sisulu University to present VMMC. Very soon THC will no longer provide VMMC in this district. Come the 30th June we will hand the baton over to Right to Care. But credit must be given to our entire team in OR Tambo for such gallant work – and being a part of history in the making.

For Right To Care, it’s their time to take the baton and run with it. I hope when the THC Team exit at the end of June 2018 they will say,”Wow we have made it”.




Cape Town’s drifters support Man Up campaign

The latest Capetonians to rally behind TB HIV Care’s Man Up campaign are legendary drifter, Malikah Daniels, and her husband, top local DJ, Ready D.

Drifting is an edgy sport, gaining in popularity in the Western Cape. Drifting events and competitions attract a predominantly male audience (perfect for our Man Up campaign) but the sport also appeals to a female audience – who love that Malikah is taking charge with her drifting skills!

Drifting, according to Wikipedia, is a driving technique where “the driver intentionally oversteers, with loss of traction in the rear wheels or all tires, while maintaining control and driving the car through the entirety of a corner”. Drivers are judged on line, angle, speed, style and “show” factor.

And of course you need a good car. Malikah’s drift car underwent a complete makeover and is now wrapped to carry the messages of our Man Up campaign.

The campaign will have a presence at various races and events over the next few months, including “First Wednesdays” where racing enthusiasts meet to enjoy cars and music. These events attract anywhere between 300 and 400 people each week; where our teams will be on hand to educate them about the benefits and importance of male circumcision. Because beyond the hype, drama and excitement we do have an important job to do. Voluntary Medical Male Circumcision (VMMC) plays an important role in our efforts to stop the spread of HIV and STIs. It prevents heterosexual, female-male transmission of HIV by 60%. It prevents the transmission of STIs, reduces cervical cancer in female partners and can also reduce a man’s chances of developing penile cancer.

In terms of sexual health, VMMC, is an important consideration. It is also quick (the procedure takes about 20 minutes under local anaesthetic), safe and absolutely free.

DJ Ready D is excited to part of the Man UP campaign and equally excited to have his wife involved. He said, “Having Malikah on board with her drift car is symbolic of the important role that women play when helping to support and encourage their guys to take the necessary steps to ensure that their health is taken care of, and get circumcised”.

To book a free circumcision, SMS your full name to 35255 and a trained counsellor will call you back. Alternatively, WhatsApp the Man Up team on 064 877 9051.

VMMC requires ‘guerilla mobilisation’ in the Western Cape, South Africa

TB HIV Care’s Deon Martin, together with a team of 10 mobilisers, enters Manenberg (a suburb on the Cape Flats) once a week to raise awareness around voluntary medical male circumcision (VMMC). They distribute flyers, pin up posters and discuss the benefits of undergoing the VMMC procedure with the community. But all is not as simple as it sounds.

The Cape Flats is an area of Cape Town with a great sense of history and community, however it is also beset with social issues: poverty, high unemployment and gangsterism.

Mobilising Manenberg

To work around the challenges posed by gangs, Deon’s team focus on one section of the community at a time. Martin explains that, ‘Mobilisation on the Cape Flats can be very “tricky” when it comes to gang areas. We need to be aware of the different gangs in the area, identify which gang controls which area – and we need to respect that before even attempting to engage with the community. We go in, mobilise and move out.’

Martin refers to this as ‘guerrilla mobilisation’.

The importance of VMMC

The risks Deon and his team encounter are worth it because of the important message they carry. Not only does VMMC cut the risk of female-to-male HIV transmission by 60%, it also reduces the spread of STIs and is now considered key in preventing cervical cancer in women. So important is VMMC that WHO and UNAIDS have called for significant public health interventions – and set massive targets for priority countries. Targets which the TB HIV Care VMMC team is set on meeting.
The biggest challenge facing the Cape Metro VMMC team is violence between rival gangs – which can break out at any time. ‘It is not always easy to mobilise gangs separately and mistakes do happen,’ says Martin.

Vigilance is key

Martin describes an incident where team members inadvertently crossed into another gang’s territory. Members of one gang were already seated in a shuttle for transport to the local clinic when they were approached by two very young rival gang members with guns. They threatened to shoot all the passengers in the vehicle. Fortunately, the driver took quick action and put his foot flat on the accelerator, swiftly avoiding a very dangerous situation.

For Martin, it is critical to remain vigilant at all times. ‘By vigilant, I mean being observant and aware of your surroundings. You can feel something brewing, such as a rival gang crossing into another gang’s territory. The tension in the atmosphere changes, the ranks of the local community will alter, the body language changes and there is a lot of whispering going on. Subtle things like that.’

Martin and team engage with the community on a Monday, recruiting clients for circumcision on a Wednesday at the Woodstock Community Health Centre. They have been successful in recruiting large numbers in the area and many of their clients are gang members. A total of 402 men were circumcised between October 2015 and September 2016 at the Woodstock facility.

Mobilising separately is ‘number one rule’ for Atlantis

A similar situation is playing out about 66 km north on the West Coast. Here, Gordon Alexander leads a team of 18 mobilisers in the Atlantis area. Alexander echoes the sentiments of Martin, and stresses the importance of mobilising gangs separately. In fact for Alexander, this is ‘the number one rule.’
Alexander remembers an incident where a member of one gang was at the clinic for his follow-up appointment when three rival gang members walked in. They recognised the lone rival gang member and the situation quickly escalated. At first they made verbal threats, but soon showed him their guns. Alexander managed to intervene and ushered him safely out the back door and into a taxi. In previous incidents in the community, this patient had been shot three times by this particular gang. Alexander explained, ‘This was an unusual and unfortunate case as this particular patient had missed his original follow up appointment and under normal circumstances would not have been at the clinic on the same day as the rival gang.’

Door-to-door canvassing

Alexander is on high alert each time he enters Atlantis, ‘On entering an area you don’t need a map, the signs are there. I might not know the area very well but I know gangsterism, which means I know the methods and behaviour of gangsters. When dealing with actual gang members it is essential to discern which member is the leader of the gang as he is the one controlling events. He is usually the quiet one and will stand back and watch. That is the one you need to talk to, as the others follow his orders. Some psychology is used in these instances; you tell them that the mobilisers are service providers who are there to offer a free service that benefits the whole community. It is a psychological game that is being played out. When you provide a service for the community the gangs are actually very appreciative.’

Door-to-door mobilisation is an important part of the VMMC’s strategy. But in these communities, it can be a highly charged situation. At least three members of the team travel together. The strategy is that two members enter the house, while one stays at the door. But, as Alexander says, ‘When there is a war going on you cannot go into the area, or if you are already in the area, you need to leave immediately.’

According to Alexander, mobilisers working in Atlantis or the Cape Flats need to be ‘street wise’, ‘vigilant’, understand their surroundings and ‘never take anything for granted.’

Just another day in the fight against HIV.