New Vision (Kampala)

3 April 2007

Uganda: Govt Plans Countrywide Circumcision

Kampala — GOVERNMENT is to embark on a vigorous training programme of medical personnel to implement countrywide male circumcision as an HIV/Aids preventive method, said Dr. Sam Zaramba the Director of Health Services in the Ministry of Health.

UN health agencies last Wednesday endorsed male circumcision in the panoply of arms to fight the spread of Aids, stressing that its success also depended on safe-sex awareness, sensitivity and resources.

"We have to improve our health services in order to provide safe operation. As much as circumcision may seem a simple surgical procedure, it may have serious consequences on the spread of HIV/Aids," Zaramba said.

The UN also warned countries to carefully assess their needs in funding, trained personnel and medical equipment, before promoting a circumcision campaign, to avoid botched operations.

"We have to do a lot of training and sensitisation. Previously, circumcision was mainly carried out by cultural people like the Bagisu, and it was spreading Aids instead. A few clinics would also offer the service expensively. We have to facilitate the Healthcentre 4s and equip them well to be able to provide the service," Zaramba added.

The UN spur for the recommendation follows three studies conducted in Uganda, Kenya and South Africa, which found that men who had been circumcised reduced the risk of HIV infection by between 51% and 60% compared to their uncircumcised counterparts.

"The efficacy of male circumcision in reducing female-to-male transmission of HIV has been proven beyond reasonable doubt. This is an important landmark in the history of HIV prevention," said the World Health Organisation and UNAIDS.

The agencies declared that millions of lives could be saved if circumcision is widely and safely practiced. According to figures published in the Public Library of Science Medicine that were cited in the UN document, five to seven million new cases of HIV infection and three million deaths could be prevented over 20 years if male circumcision is universally practiced in sub-Saharan Africa.

"Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention, which can reduce the risk of HIV infection in heterosexual men," said Kevin de Cock, director of WHO's HIV/Aids department.

Zaramba says that the main challenge is for the population to think that circumcision is a solution to the scourge hence jeopardising all our past achievements.

"We have to do a lot of health education. We need the media's help. We also appeal to the public to wait until the wound heals before engaging in sex, because it can be traumatising and may cause infection.

"Circumcision is going to be part of a prevention package that also includes safe-sex counselling and access to condoms for both partners. In our case, it is going to play along our traditional ABC strategy," he says. The ABC strategy advocates for abstinence, faithfulness and use of condoms.

Dr. Sam Okware, the commissioner health services says that the ministry has set up a task force under the Uganda Aids Commission, headed by Dr. Apuli Kihumuro, to review all the studies and see the way forward. "There are issues with the recommendable age of circumcision, which health workers qualify to conduct the procedure, method of implementation, logistics, incorporation of cultural leaders and a lot more," he said.

Okware says that their next steps will depend on the recommendations of the task forces. The clinical reason for circumcision's preventive effect is still being investigated.

One theory is that the foreskin has a very thin lining and suffers minor abrasions during intercourse, making it easier for the human immunodeficiency virus (HIV) to enter the man's bloodstream.

Another is that the foreskin is rich in Langerhans cells, whose surface is configured in such a way, that the Aids virus readily latches on to them.

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