Throughout Siaya county, which one of six counties in Kenya (out of 47) where circumcision is not a cultural practice, an estimated 200,000 VMMCs have been performed since 2008. This is done through ICAP, not a GF recipient, and with support from PEPFAR. However, they receive monitoring and coordination support from NASCOP, which is a GF recipient.

When a client comes to the clinic for VMMC, he receives consultation first. Part of the message is that circumcision only offers partial protection. Right after consultation, which lasts for 30-45 minutes, the client moves on to the room next door for actual circumcision. Surgery takes about 15-20 minutes with local anesthesia. It’s a thorough process. Afterwards the man receives an emergency phone number in case of complications, painkillers. After 7 days there is a follow-up meeting.

One challenge is the fact that VMMC puts men out of work for 1-3 days. A new method called PREPAX is being rollout out, which reduce time that men are unable to work and is (relatively!) painless. However, it’s currently quite expensive compared to the regular method, and only used in a few cases (so far), about 145 in the region. Another challenge, especially among the chauvinist Boda Boda, is that the young men are afraid of being laughed at by their peers.

The man we see receiving voluntary counseling at the Nyawara Health Center is 35-year-old George Obongo. He learned about the VMMC program through a roadshow (like the one shown later this day). He says even the bible says Jesus was circumcised. He is not scared of getting infected with HIV, but wants to be an example for his 16-year-old son, whom he wants to bring for circumcision too.

About 5-6 people typically get circumcised at this health center every day, but often it’s more. The center covers a population of 100,000 people.


After the roadshow we go back to the Nyawara health center to witness an actual circumcision in the operation room. The individual wears a black t-shirt, and is not the same person who is seen receiving counseling earlier. Sam tries to take some discrete photos of the event.