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Kenya is in the middle of a groundbreaking public health effort to curb the spread of HIV. It's attempting to get more than a million men circumcised by the end of 2013. Other African nations have launched circumcision drives but none has been as successful as Kenya's. So far, more than 400,000 men have undergone the procedure.
NPR's Jason Beaubien reports the Kenyan Ministry of Health is using blitz of advertising, community organizers, and mobile clinics to get uncircumcised men to go for what they're calling The Cut.
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JASON BEAUBIEN, BYLINE: This is Kisumu, a city of about a half a million people in western Kenya. It's on the shore of Lake Victoria near the border with Uganda. In the streets here, bicycle-taxis known as bodabodas mix with cars and three-wheeled jitneys and overcrowded matatus, the vans that serve as the main form of public transportation here.
Kisumu is home to the Luo tribe. It's also the heart of the AIDS epidemic in Kenya.
DR CHARLES OKAL: In the province where we are, it is not a culture that men are circumcised.
BEAUBIEN: Sitting in the overgrown garden of the Kisumu District Hospital, Dr. Charles Okal says when they launched the circumcision drive here in 2008, many people scoffed at it. Okal is the provincial coordinator for AIDS and sexually transmitted infections. He says friends told him he'd never be able to get Luo men to go against tradition and voluntarily be circumcised.
OKAL: We had to convince the community that this is a procedure which is proven that it will help us reduce the prevalence rates of HIV that we have.
BEAUBIEN: And those rates are high. A study by the Kenyan government in 2007 found that uncircumcised men in the country are three times more likely to be HIV-positive than their circumcised counterparts. That same year, another study showed that circumcising adults reduced their risk of contracting the virus by 60 percent.
Health officials decided to launch an all-out offensive to convince Luo men to change their customs and get The Cut.
UNIDENTIFIED MAN: ...male circumcision...
BEAUBIEN: The campaign involves foot soldiers driving around neighborhoods with bullhorns, preaching the benefits of the free procedure. They canvas markets handing out leaflets and trying to sign up men for appointments at local health facilities from. Special mobile circumcision clinics are set up in gyms, churches, youth centers, and even in tents in some remote villages. A program was launched to train nurses and other health care workers in how to perform the operation.
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BEAUBIEN: Twenty-four-year-old Mercy Aching is the only woman sitting in the waiting area of a circumcision clinic in Kisumu. Aching has brought her two younger brothers to be circumcised. Sixteen-year-old Lucas is currently in the operating room, 15-year-old Hemsted is up next.
MERCY ACHING: We've lost our mom, our mom and dad because of HIV-positive. So they don't like that disease. Yeah.
BEAUBIEN: The lanky Hemsted slouches in this chair next to his older sister. He isn't very talkative. But Mercy Aching says her brothers pleaded with her to bring them in for the procedure.
ACHING: You know, in Nyanza, many people are not circumcised but now everybody. Yeah, everybody circumcised and even these small boys, they want to this thing. And they wanted it because many of their parents are dead because of HIV. So I think they want it real so much.
BEAUBIEN: Health officials here say teenagers have accepted circumcision, but it's been much harder to sell the idea to men in their late 20's or older, even though those older men have seen more of the devastation AIDS has caused. In just about any social situation, it's difficult to discuss cutting a delicate part of someone's body. But in Africa, circumcision also carries major cultural implications.
Among many tribes it serves as a right of passage into adulthood. Among others the foreskin has been viewed as part of their cultural identity. During the deadly tribal clashes in Kenya in 2007 and 2008, there were reports of Kikuyu youth forcibly circumcising Luo men in the streets.
But some of the resistance to this public health campaign is much simpler. Men who earn just enough money each day to feed themselves and their families don't want to be off work while they heal.
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BEAUBIEN: At the fishing village of Osindo on Lake Victoria, long, narrow, brightly-colored wooden boats are pulled up on the beach. So-called community mobilizers from the Nyanza Reproductive Health Society have set up a table with brochures under a tree where the fishermen normally weigh their catch. The health care workers brought a giant boom box to attract attention.
About a dozen highly-skeptical men crowd around Kwinta Ochola asking her why they should participate in the circumcision program.
The men fish here by wading through shallow parts of the Lake Victoria, dragging large nets. Ochola explains that after the operation they'll have to stay out of the water for at least three days.
KWINTA OCHOLA: Or maybe bed for three days. Three days (Foreign language spoken)
BEAUBIEN: The chairman of the fishermen wants to know who's going to pay these men for their lost earnings. He says they can't afford not to work for three days.
The only material compensation offered after the surgery is a bottle of warm orange soda and a pair of tight white briefs. Counselors also explain safe sex practices. The men are tested for HIV and offered access to treatment if they're positive.
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BEAUBIEN: Nationwide, AIDS has had a deep impact in Kenya. Roughly six percent of adults are infected with HIV. On this morning, an AIDS support group is convening at the Siaya District Hospital. About 60 people are sitting under the broad canopy of an acacia tree in the courtyard of the compound. A blind man complains that the generic AIDS drugs given out at the hospital all come in the same sized bottle and he can't tell them apart.
UNIDENTIFIED MAN: (Foreign language spoken)
BEAUBIEN: After him, a woman talks about how she's been so sick she can no longer work in her cornfield.
In the building just behind the AIDS support group, five young men are lined up in a clinic waiting to be circumcised. Among youth here, it's become the thing to do.
Twenty-year-old Benard Otieno had the procedure at this clinic three years ago.
BENARD OTIENO: I decided to come and to reduce the chances of me getting the killer disease.
BEAUBIEN: Otieno is in college. He's studying to be a primary school teacher. He says he'd seen the advertisements about male circumcision but it was his friends who convinced him to go get The Cut.
OTIENO: And now, I'd say 90 percent of my friends are now circumcised.
BEAUBIEN: Now he views circumcision as a patriotic act. Otieno says he and his friends talk about wiping out AIDS in Kenya.
OTIENO: We want to be a generation without HIV-AIDS. So, circumcision will help the future of Kenya.
BEAUBIEN: If Kenya can stop having to deal with HIV, he says, the country will have more money to spend on roads and schools and development.
Jason Beaubien, NPR News.