10 April 2007

Uganda: HIV - Circumcision Isn't Enough

Experts argue that circumcision alone can never prevent the spread of HIV/Aids but it is yet to be understood by the layman.

37- year old Mukasa is not circumcised but is considering it seriously. "I have heard that if you get circumcised, you cannot catch HIV/ Aids. I don't have to use a condom or worry about all those other ways of keeping safe. I finally get a method that suits me..." he says. Mukasa is obviously oblivious of the almost negligible but very important fact surrounding the hyped circumcision as an option to HIV/Aids prevention.

Experts argue that circumcision alone can never prevent the spread of HIV/Aids but it is yet to be understood by the layman. In Uganda, many people are storming clinics, hospitals and quack 'surgeons' for circumcision, barely informed or sensitised in detail about how exactly they will survive HIV through it.

It can't be ruled out either that the many local 'surgeons' who circumcise within the community could also be as ignorant. While many are excited about this information on circumcision, others still grapple with understanding basic knowledge on HIV/Aids.

Yet it is now official from WHO and UNAIDS, the United Nations joint programme on HIV/Aids that male circumcision is recommended as an option to fight against the scourge.

A joint statement by the two bodies, recommended that male circumcision be included as part of a comprehensive HIV prevention package.'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," the statement quotes Dr Kevin De Cock, the Director of HIV/ Aids department in WHO.

Adding that 'scaling up male circumcision in such countries will result in immediate benefit to individuals. However it will be a number of years before we can expect to see an impact on the epidemic from such investment."

This came from evidence after an international expert meeting earlier in the month. It comprised experts who had carried out randomised trials on circumcision that had proven that it reduced the risk of acquired infection of HIV/ Aids by 60 percent.

The trials were done in Kisumu in Kenya, Rakai in Uganda and Orange Farm in South Africa. The recommendations come with the need for extensive sensitisation.

"It has been known that male circumcision is good and many men have done it, however recommending it as a measure is quite controversial because some people may think that it is the only way and may not consider the other options of prevention," says Dr Vincent Karuhanga of Friends' Poly Clinic, Kampala Road.

He argues that under some circumstances the promotion of circumcision could down play the important ABC crusade. " The best way it can work is by first carrying out massive education on circumcision and emphasising that the practice alone cannot save them," Karuhanga says. Compared to Abstinence, Being Faithful and Condom use, circumcision at sixty percent still gives a forty percent risk exposure, which must not be ignored.

"People should not rush for circumcision as the ultimate, because there are many circumcised men who have been affected by HIV. Although they are less likely to acquire HIV/ Aids that doesn't necessarily mean that they are totally safe.

WHO and UNAIDS however recommend that there should be counselling for men and their sexual partners, 'to prevent them from developing a false sense of security and engaging in high risk behaviours that could undermine the partial protection provided by male circumcision.'

They also advise that the health services need to be strengthened to provide quality services. Circumcision under the best clinical and hygienic conditions comes at a high price and many Ugandans cannot afford it. For instance Kibuli Muslim Hospital charges between Shs30,000- 60,000 depending on the condition of the patient.

In other private clinics the cost is even higher at an average of Shs50,000 to 100,000.

This leaves the local 'surgeons in the community or at the mosque as an option because they are supposedly cheaper.

According to Dr Mahmoud El- Gazar, the Kibuli Hospital Director, the hospital also receives many casuality cases of circumcision gone wrong, courtesy of untrained personnel or poor hygienic conditions.

Dr Jacinto Amandua the Commissioner of clinical services acknowledged the reception of the report and recommendations but said that it would require consideration first.

"There is some evidence that circumcision can prevent the spread of HIV to a certain extent, but we shall have to adopt it depending on the decision of the government," he told Daily Monitor in an interview.

He also argued that although circumcision is a common practice it has been recommended before for health and hygienic reasons so recommending it for HIV prevention is as controversial as condom use. It is not good for it to be thought to work alone and therefore a lot has to be done for people to eventually understand it's new role.

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