Southern Africa in circumcision drive to fight Aids

2010-07-16 10:24

Thomas Mukone wonders exactly how he would tell his wife that he

wants a circumcision at age 41, even with the government in Zimbabwe urging

adult men to get snipped to slow the spread of Aids.

He says: “It’s not easy to discuss this as she is bound to accuse

me of promiscuity. It is a really nice programme, but how will I tell my wife

that I want to go for circumcision?”

Zimbabwe has joined the growing list of countries in southern

Africa that is pushing, and sometimes paying, for adult men to get circumcised,

in the wake of studies that found men without a foreskin are 60% less likely to

contract HIV.

Scientists think this is because the foreskin has more cells that

are easier for HIV to infect. The findings have sparked a regional drive to make

circumcision a routine party of prevention efforts.

Zimbabwe aims to have 30 000 men undergo circumcision by year end,

said Owen Mugurungi, head of the national HIV prevention programme.

But it’s an ambitious target – 82 men would have to get trimmed

every day in a country where the medical service struggles to provide basic

care.

Mugurungi said 4 000 men have taken part so far, including many in

the army, and donor funding means the procedure is free for volunteers.

But convincing men to undergo the procedure requires tackling

issues both complicated and intimate in the region hardest hit by Aids.

Mugurungi says: “In many households, the issue of circumcision is

still treated with suspicion and we need to do more campaigns to educate the

public.”

Trials in Kenya and Uganda have shown that circumcision, while far

from being a silver bullet, dramatically reduced the number of new infections

for men.

Uganda, a pioneer in HIV prevention, is currently running

television and radio campaigns to encourage men to visit clinics for safe

circumcision procedures.

Botswana has launched a scheme to circumcise 500 000 men – a

quarter of the total population – by 2012.

Zambia, Lesotho and Swaziland all encourage circumcision as a

matter of policy, and South Africa is running a pilot project to offer free

circumcisions.

Each country is facing its own hurdles.

In some communities, circumcision is practised as a rite of passage

for teenagers, where Xhosa boys are taken to initiation schools where their

foreskins are cut by traditional doctors of varying competence.

Every year, dozens of boys die of complications from the procedure,

while scores more suffer amputations or gangrenous infections. That can scare

off potential volunteers from safe medical circumcisions performed in

clinics.

Zulus abandoned the tradition more than a century ago but their

king has proposed reviving the practice to fight HIV, with trained medical staff

doing the work.

In countries like Swaziland, where HIV infects 26% of all adults,

circumcision trials began five years ago and worries have already sprung up that

after the procedure men see less need to use condoms, creating a new HIV

risk.

Still, the country is aiming to circumcise 80% of men aged 15-24

over the next four years.

The question remains, will the men participate?

Malawi has refused to look at circumcision as an option, saying it

is too difficult culturally for people to accept.

Mary Shawa, head of Malawi’s Aids and nutrition programme, says:

“Malawi is not a circumcised country, so circumcision cannot work. It’s very

difficult to implement as a policy.”

Still, across most of the region billboards are sprouting up like

those in Zimbabwe, which show five footballers forming a wall in front of the

goal line, under the message: “Male circumcision is one of the top defenders

against HIV.”

Admire Murerwa (21), a street vendor selling his wares a few metres

from the sign, is not convinced. He says: “Yes, circumcision is right. But I

still think the condom is better to reduce HIV infection. Circumcision is right

but it also depends on how one behaves for you not to be infected.”


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