Saving Nsombi Island from ravages of Aids


Chrissy Assani, 28, from Nsombi Island on Lake Chilwa used to believe that once her husband is circumcised, their sexual life would be affected.

Whenever she heard news about Voluntary Medical Male Circumcision (VMMC) she discouraged her husband to undergo the procedure.

“Circumcision here is done by initiation counselors, but at a tender age. I thought circumcision is only for young boys and that if one is circumcised in his adulthood, sexual life will be affected,” she said.


But Assani had her mindset changed when Jhpiego, an international organisation which works towards the improvement of the health of women and their families, went to the island.

“Jhpiego provided civic education. We were told that Voluntary Medical Male Circumcision reduces the risk of female-to-male sexual transmission of HIV. We were also told that circumcision reduces cases of cervical cancer in women,” she said.

Male circumcision is a proven intervention that offers partial protection against sexually acquired HIV in men.


The World Health Organization and UNAIDS recommend that it should always be considered as part of a comprehensive HIV prevention package which includes HIV testing and counselling; correct and consistent use of female or male condoms; treatment for sexually transmitted infections and promotion of safer sexual practices such as avoidance of penetrative sex.

Made aware of what VMMC was all about and its importance, Assani urged her husband to be circumcised.

Nsombi Island is one of the many areas where Jhpiego is implementing the VMMC project.

The island has a population of around 3,000 people but that is enough to make it a hub for the spreading of HIV and Aids across the country.

Fishing is a major way of earning a living on the island such that traders visit the island from the mainland to buy fish and the islanders also travel to the mainland to sell fish.

This fluidity makes the island a vortex of HIV transmission, consistent with findings by various studies showing how fishing has become a ground for sexually transmitted infections owing to the fact people from different corners converge at one place and wait for days to buy fish.

Some studies have even found that women fish traders are particularly vulnerable because for them to get around the difficulties faced in accessing fish from the fishermen, they have to offer themselves for sex if at all they are to be served quickly.

Group Village Headman Chisoni at the island says the exercise by Jhpiego came at the right time as prevalence rate of HIV at the island was high due to the fishing business there.

“Most of the people here are fishermen, and when they make money, some of them indulge in sexual activities. Yes we have condoms, but that is not enough. When some people are drunk they forget to use condoms.

“We are neglected here; we were just hearing stories to do with circumcision on the radio, and we had problems to understand this, but we are happy that Jhpiego implemented this project here. When they provided civic education, people overwhelmingly responded to the call,” he said.

Jhpiego Team Leader for Zomba Whyson Mkandawire said the exercise has so far seen 402 people getting circumcised with 168 of them aged around 15 years.

But Mkandawire bemoaned that the exercise has been dogged by challenges.

“Lack of a health facility [on the island] made it difficult for us to link VMMC with other services when need arises i.e. referring for HIV care and other medical services. And adults did not come for services despite following their request even to do moonlight services,” he said.

He said some people that are living with the virus were not interested to undergo the procedure because they felt that VMMC would have no impact on them.

“Some cannot afford to abstain from sex for six weeks as required after VMMC and others have probably myths about VMMC. Accessibility of the island is also another challenge because Nsombi is a hard to reach area hence many supplies were taking long to reach the site as we waited for scheduled boat trips to reach the area.”

However, the organisation’s efforts have been well received by people like Jones Kasawala who said he did not regret that he decided to undergo the procedure.

“At first, initiation counselors were responsible for circumcision, but safety was a problem. Therefore I urge my fellow men to be medically circumcised. It is not painful and the healing process does not take long,” he said.

Traditional initiation counselor Taulo Mingwa admitted that safety was a problem as they were using one razor blade to circumcise two or three people.

“We are no longer doing that because of the coming in of Voluntary Medical Male Circumcision exercise by Jhpiego,” he said.

The VMMC campaign started in 2011 in Malawi with funding from USAID and Pepfar (President’s Emergency Plan for Aids Relief). It was piloted in Mulanje, Phalombe and Thyolo before being scaled up to Zomba, Blantyre, Chikwawa, Lilongwe and Nkhotakota.

According to the Ministry of Health, by September 2014 about 150,000 clients had been circumcised.

To date, an estimated total of 200,000 clients have so far received the circumcision.

“Routinely, the service is offered in all central and district hospitals. However, as a campaign, we are going to scale up to all the remaining districts starting in July 2015. This will be done with support from the World Bank,” said acting spokesperson for the Ministry of Health, Adrian Chikumbe.

But he noted that the campaign is still marred by challenges such as fear of the procedure and poor understanding of the difference between VMMC and cultural/ religious circumcision.

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