During the month of May, IMPACT will be highlighting USAID’s work in Global HealthFrom May 18-27 we will be focusing on an AIDS-Free Generation. 

Kawango Agot works to scale up voluntary medical male circumcision in Kenya. Photo Credit: USAID

I work as part of a team dedicated to scaling up voluntary medical male circumcision (VMMC) in Kenya. In 2007-2008, clinical trial results confirmed that VMMC has the potential to dramatically reduce men’s risk of acquiring HIV from their female partners. While Kenya and 13 other African countries have made great strides in rolling out VMMC (Kenya has circumcised about 500,000 men since VMMC was endorsed by the World Health Organization as an effective intervention against HIV), there has been a glaring gap that many of us have not paid attention to: how to get women fully on board as stakeholders, guardians, and partners. For all practical purposes, we as VMMC program implementers run our business as if this is solely a man’s affair. We forget that involving female partners is critical to turn this procedure into a successful intervention for HIV prevention.

In 2010, a small, unique group of young women in the lakeside city of Kisumu, Kenya, blew my mind away. One challenge we experience in VMMC programs is finding a way to support men through the six weeks of sexual abstinence recommended after surgery. In my attempt to encourage women to look beyond the usual topics surrounding VMMC (for example, that it reduces their risk of cervical cancer if their male partners are circumcised), and broach more difficult topics, my attention was drawn to some young women who accompanied their husbands/boyfriends for circumcision at one of our VMMC service sites. I called some of the couples for a casual chat, and was amazed at how perceptive they were in making decisions about their health.

The young women described how they discussed VMMC with their partners ahead of going for services – benefits, risks, fears, and interestingly, sexual abstinence. Each one of them narrated how, ahead of time, they agreed on sleeping arrangements that would enable them to observe the 42 days of abstinence. Some separated beds, others separated rooms, some slept on the same bed, but fully clothed, some simply dressed unattractively or avoided bodily contact or seductive talk while others took time off to visit with their families. Many reported to have successfully abstained for the recommended period, and attributed this to the fact that their partners involved them in their decision to be circumcised. As a bonus, most also tested for HIV together.

This experience shows us how crucial women’s participation is in the VMMC process, and how female partners might improve adherence to the post-operative abstinence period. These women deserve praise – ordinary women who have the courage to step out into the extraordinary and claim their space in VMMC, who recognize that their partner’s health is their health too.  To such, I bow in respect… and call on many more to come forward and claim their space in VMMC – it is your right!

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