"We are happy with the turnout - it shows our outreach efforts are working," said Sibusiso Simelane, Assistant Clinical Director at Litsemba Letfu (SiSwati for Our Hope) Male Clinic in Matsapha, halfway between the capital, Mbabane, and the central commercial hub of Manzini.

"They come for MC [male circumcision], but 92 percent of the men get tested for HIV," Simelane said. Every day 35 patients are circumcised by appointment at Swaziland's first clinic specifically for men, but walk-in patients are also welcomed; the procedure is free and those who arrive early can be out by lunchtime.

When the Ministry of Health and Human Services opened the facility in October 2009, it committed to making Swaziland the first country in the world where 80 percent of males in the age group most vulnerable to HIV infection (15 to 29 years) would be circumcised by 2014.

Clinical Director Dr Khumbulani Moyo attributed the procedure's low complication rate - 2 percent - to extensive counselling of patients and adherence to quality assurance standards established by the World Health Organization. "It all starts with the counsellors," said Simelane. "We cover the risks and benefits of MC."

Counsellors emphasise that MC only reduces a man's chances of contracting HIV by about 60 percent and should be combined with other prevention strategies. "We ask the patients to come with their partners, so they will also understand the procedure, and know why they cannot engage in sex for six weeks during the recuperation time," said Simelane.

Sipho, 20, a farm worker, silently deliberated for several minutes before completing the form consenting to the elective surgery. "The health motivator told me about this place; she told me about circumcision and even arranged transport," he said.

The next step is a counselling session, during which he is told the results of his HIV test before undergoing the 20-minute procedure. He is given a local anaesthetic, and tries "not to not think of the doctor cutting" while he listens to soothing music on the radio. Soluble sutures are used to save him a return trip to the clinic.

With funding from the Bill and Melinda Gates Foundation and the US President's Emergency Plan for AIDS Relief, health motivators are sent around the country to raise awareness about the clinic's services by Population Services International (PSI), a non-profit social marketing organization.

"They go to rural areas and find patients at schools and community centres. Private companies request presentations to be made to their staff," said Jessica Green, the clinic's Technical Services Director.

The health motivators collect contact information from men expressing an interest, and clinic staff follow up to make appointments. The clinic will start offering treatment for all sexually transmitted infections in 2010.

"A clinic for men is exciting because it gives men a chance to come together and discuss their health," said Bongiwe Zwane, a communications officer at PSI Swaziland. "They tell their friends about this place, which is very professional and confidential; word-of-mouth has been very positive."

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