Background: Jhpiego with support from the United States Agency for International Development has supported the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children to implement VMMC services for HIV prevention since 2009 serving over 890,000 clients to-date. In 2016, a new approach of using local volunteer community advocates (VCAs) to refer VMMC clients to routine facilities allowed phasing out of employed nonlocal community health promoters. With the change to VCAs, the AIDSFree project increased engagement of women by a female-to-male ratio of 2:3 despite previous concern that sexual taboos and busy schedules would hinder women from being effective VCAs in promoting VMMC as it relies on male decision-making. This analysis compares the performance of female versus male VCAs in driving the successful uptake of VMMC services.
Methods: A retrospective review of the AIDSFree project database was conducted to extract VCA performance data from 1 October 2017 to 30 September 2018. We compiled performance data on interpersonal communication activities to increase VMMC uptake in routine facilities performed by VCAs such as door-to-door campaigns targeting adults. Performance was assessed at a scheduled biweekly meeting between each VCA and a project mentor using the same scale for male and female VCAs. Scores assigned by project mentors on a scale of 1 (not implemented) to 6 (fully implemented) for each activity the VCA planned to achieve facility-level targets were converted into a collective percentage average and compared by sex.
Results: 227 VCAs supported VMMC services during the review period (93F, 41%). Among these, 103 VCAs (45%) who served for the full year were selected for analysis (42F, 41%). Selected VCAs completed 2,266 biweekly assessments with an average performance score of 83% (range=57%-100%). Male VCAs scored 83% (range=62%-100%) and female VCAs scored 83% (range=57%-100%).
Conclusions: In line with field reports by project mentors, the results underline that social norms and domestic roles do not hinder female VCAs'' performance as local VMMC promoters. Engaging local women as VCAs can influence VMMC perceptions positively and provides a more balanced perspective and approach to VMMC promotion.