Background: HIV prevention has reached a new era, marked by biomedical advancements in HIV prevention such as voluntary medical male circumcision (VMMC) among others. Faced with the world''s highest HIV prevalence (31% among 18-49 year olds), the Government of Swaziland, with support from the United States Agency for International Development (USAID) and technical assistance from the Centre for HIV/AIDS Prevention Studies (CHAPS), aims to increase uptake of VMMC, especially among males aged 15-29 years, to have an immediate impact on HIV incidence. Over the past 5 years, the proportion of men circumcised in this age group has declined from 78% (2010) to 26% (2015).
Description: in 2015, CHAPS engaged 3 private practitioners in April 2015 on a cost per circumcision basis, after a positive experience with private doctors in South Africa. Private practices can be attractive for men, who often don''t visit public facilities (long queues, poor service, focus on maternal and child health, no privacy, lack of trust in quality of the service). CHAPS provides an MC kit, training and quality assurance. The private practice does demand creation, provides the service and assures follow-up.
Lessons learned: Private practitioners successfully reached 15-29 year olds (45% of all private clients), a significantly higher proportion than the other partners (27%), at a cost per circumcision of US$ 65 (SZL 900). Practitioners recruited among existing clients, in high schools and in workplace settings around their practice. Men are taking up VMMC in a men friendly setting.

Circumcisions per age category and provider type
[Circumcisions per age category and provider type]

Conclusions/Next steps: Engaging private practitioners is a cost-effective strategy to reach 15-29 year olds. CHAPS is expanding the private practitioners'' network, and is exploring to incorporate best practices in public VMMC sites where feasible: providing a men friendly setting and focusing recruitment efforts in high schools and workplace settings.

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