New Mid-level Medical Cadre Supports South Africa’s Push for Voluntary Medical Male Circumcision as a Key HIV Prevention Strategy
“When I counsel my patients on voluntary medical male circumcision (VMMC), I inform them about the many benefits of the procedure, as well as the risks they face by remaining uncircumcised,” says Clinical Associate Mokho Eliza Mabina, who works at Metsimaholo Hospital in Sasolburg, a large industrial town in the far north of the Free State province of South Africa.
The World Health Organization and UNAIDS have recommended VMMC as an important strategy for preventing HIV – particularly in settings with high HIV prevalence and low levels of male circumcision – since 2007. These organizations report that the procedure reduces the risk of female-to-male sexual transmission of HIV by roughly 60 percent, which led the South African Department of Health to add VMMC as a key prevention strategy in its HIV response in April 2010.
Working at Metsimaholo Hospital’s CHAPS (Centre for HIV and Aids Prevention Studies) Clinic, Mokho says she sees about 80 men seeking VMMC services each week. During school holidays and other busy times, that number is much higher.
“The benefits of VMMC are the obvious risk reduction for HIV and other sexually transmitted infections, especially ulcerative infections,” Mokho explains. “It is easier to keep clean, so improved personal hygiene is another benefit. It prevents phimosis (overly tight foreskin) in young boys, paraphimosis in older men, and the transmission of human papillomavirus (HPV) – which causes cervical cancer – to their female partners,” she continues.
“I don’t come across much resistance, but I have had a few encounters where patients were uncomfortable because of my age and gender,” says Mokho, who is 23 and completed her Bachelor of Clinical Medical Practice at the University of the Witwatersrand in 2013. “I reassure them I am a well-qualified Clinical Associate and very confident in the skill,” she acknowledges with a smile.
“I work with a team of nurses to ensure that we provide the best service for our clients. I am responsible for the surgical procedure, as well as for follow-up exams and responding to any adverse events,” Mokho continues, noting that her team also visits area prisons to offer VMMC services there.
On average, Mokho says she sees about 45 patients each day, with roughly 20 percent of the patients seen at the hospital living with HIV. In the prisons, it’s closer to 50 percent.
“I think Clinical Associates play a vital role in the country’s healthcare service because we’ve been trained to provide services in the rural health division and for district hospitals. This is where our services are needed and appreciated,” Mokho points out.
“My training at Wits prepared me well for my current position and I also successfully completed a formal training with CHAPS. Most Clinical Associates at VMMC sites are team leaders and some even hold management positions,” she says. “Our commitment and love for what we do has a positive impact on our job and often carries us through any challenges we face.”
Clinical Associate Mokho Eliza Mabina (top) performs a medical male circumcision at Metsimaholo Hospital’s CHAPS Clinic in Sasolburg, Free State province. Voluntary medical male circumcision (VMMC) is a key intervention for preventing the spread of HIV in South Africa and Clinical Associates, a new mid-level medical cadre, are playing a critical role by providing the service, especially in rural and underserved parts of the country.
The University of the Witwatersrand is one of three South African universities currently training Clinical Associates. With support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Centers for Disease Control and Prevention (CDC) in South Africa, the American International Health Alliance (AIHA) established a twinning partnership linking Wits with Emory University in Atlanta to strengthen the South African institution’s Clinical Associates program through faculty and curriculum development and other peer-to-peer technical assistance. As a one-time intervention, VMMC can provide men with a lifetime of protection against HIV and STIs. Clinical Associates play an important role in the provision of VMMC services, particularly in underserved rural settings, and are thereby an integral component of South Africa’s HIV prevention strategy.