The Chronicle Newspaper (Lilongwe)
Cedric Nkungula
16 July 2007
analysis
Lilongwe — It is towards mid-day in the course of a summer term holiday in the famous lakeshore, tourist resort district of Traditional Authority Jalasi, Mangochi in Malawi where a number of people have gathered dancing, whistling and wriggling their bodies like nobody's business.
Soon, the master of ceremonies pleads for order signifying the arrival of a group of young men all dressed up in white attire holding a handkerchief to their mouths.
Everybody gets over-taken by the event and the parents in particular are on cloud nine. Of course, who could blame them? Certainly they are happy that after undergoing a special counseling, their children have become adults.
Yes they have been taught real facts of life and above all --- have been circumcised.
In Malawi circumcision, widely regarded as a Muslim culture is undertaken at puberty as part of an important rite of passage into manhood.
At a time when HIV/AIDS continues to have a devastating impact on almost everybody, especially on girls and women, government and all the stakeholders are working to capacity, trying to find a lasting solution to stops the spread of infections.
Research work being carried out by expert to find ways to stop the pandemic has come up with male circumcision as a possible intervention in the fight against HIV. According to resent research results, increasing evidence shows that male circumcision offers some protection against HIV infection in men apparently reducing the risk by about half or more. The protective effects of circumcision have also been known to extend to Sexually Transmitted Infections (STIs).
Researchers have found out that uncircumcised men are between 2 and 8 times more likely to be infected and statistics indicate that the infection rates are higher in countries where the practice is rare than in countries where most men are circumcised.
The research has identified several biological aspects of circumcision before puberty. It says risk to uncircumcised men may be greater because the foreskin contains HIV targeted cells.
In addition to the foreskin being more vulnerable to various STI infections, Virologists believe that HIV spreads more easily via the special immune receptors known as Langerhans Cells which are highly concentrated in the foreskin and other genital mucosa but largely absent from the circumcised men, according to a book AIDS Africa - continent in crisis.
However, male circumcision is a deeply emotive subject rigidly adhered to within some religions and cultures and equally strongly opposed by others.
The question of making circumcision another strategy in the fight against HIV/AIDS has been discussed by many but some religious people feel that making circumcision a strategy without the including the importance of behaviour change will not halt the further spread of HIV.
Sheikh Dinala Chabulika of Muslim Association of Malawi Information Bureau says "Am afraid circumcised men will go on rampage. Certainly, we don't want that, the message of abstinence is very important."
Chabulika says according to scientists, it is true that circumcised men stand a better chance of avoiding the becoming infected with the virus but warned that the 'practise' as a tool in the fight against HIV/AIDS without the importance of non-involvment in risky behaviour could create the wrong impression
" Of course it is true, even the principles of Islam agree. The foreskin of uncircumcised man usually has cracks where the HIV virus gets through. This then means that circumcised men are safer," he emphasised.
Chabulika said circumcision is no longer an Islamic issue and he claims there are a lot of Christians who are getting circumcised for hygene reasons.
" We know we have qualified doctors in our hospital who get people circumcised at a fee. Its very safe," he insisted
However, Chabulika warned circumcised men to refrain from indulging in immoral behaviours on the pretext that they are circumcised.
"Do not be too proud," warned Chabulika. "There are risks associated with it. Even those that are circumcised can catch the virus."
Malawi Network of People Living with HIV/AIDS (MANET+) Programmes Officer Victor Kamanga says more information on how circumcision can play a part in the reduction of infection of HIV/AIDS has to be made available to the public
" If HIV/AIDS cases and other infections could be reduced if people are circumcised then its something that should be looked at and carefully planned so that it does not develop apathy," said Kamanga.
Reverend Father Macdonald Sembereka of Malawi Network of Religious Leaders living or personally affected with HIV/AIDS (MANERELA) said he would love to see people talk of safer practices.
He said though circumcision is such one practice, those that are circumcised should not believe that they are immune to the virus .
"There are a lot of people that are circumcised and have contracted HIV/AIDS. Why can't we emphasise on safer practices so that those who are positive remain positive and not transmit to others and those that are negative remain negative," said Father Sembereka.
National AIDS Commission Director of Policy and Programmes Roy Hauya said research that circumcision reduces the spread of HIV/AIDS and STIs is not yet concluded and it is rather too early to make it a strategy in preventing transmission.
"The research is not yet concluded and it can be misleading to start telling the people that circumcision prevents people from contracting HIV and AIDS as well as STIs," said Hauya.
Three trials in Eastern and Southern Africa have so far been undertaken in recent years to assess through controlled research benefits of male circumcision in preventing HIV transmission.
The study in South Africa's Gauteng Province was halted earlier than planned because the results very strongly indicated that circumcision was protective from HIV transmission and researchers believed the procedures should be extended to all of the 3,274 men participating.
It is yet to be seen whether the country will incorporate circumcision as another tool in the fight against HIV infection together with the popukarly known ABC - abstinence, faithfulness and using condoms correctly.
Current statistics indicate that approximately 14% of the country's population of about 12 million has the virus.
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