19 October 2007

Uganda: Stick to the ABC Strategy


Kampala — Uganda is one of the developing countries debating whether or not to adopt circumcision as a tool to fight HIV/AIDS and other sexually transmitted diseases (STDs).

Recent media reports have indicated an increase in the number of men going to clinics to be circumcised. This scenario is attributed to the belief and recent studies both in Uganda and outside, that the 'surgical attack' on the penis could finally defeat the HIV/AIDS pandemic.

Circumcision is one of the oldest practices globally. The procedures are mainly based on religious, cultural and medical reasons. Reliable figures indicate that over 13 million male children are circumcised annually. A report by the World health Organisation (WHO) in 1998 shows that

5% of the female world is circumcised and that in Egypt, over 90% of the women are circumcised.

Male circumcision is practised by Jews and Muslems. Besides this group, a reasonable number of Christians, especially in the Sudan, Ethiopia and other countries carry out the practice. Circumcision in the USA was reported at 70% in 2001, being carried out routinely neonatally for medical reasons.

Circumcision dates as far back as the biblical days; Genesis 17:1-14, when Abraham, at the age of 99 years, told the Jews to circumcise as a covenant between god and the people. Hence, on the eighth day, Jesus' parents fulfiled what Abraham had asked the people of Israel to do.

However, the same Bible makes a distinction between the physical and spiritual circumcision. (Deuteronomy 19:21, Corinthians 7:17-20), hence the current baptism and not the old practice of nipping off the foreskin as a covenant.

According to Saudi religious authorities, a man who converts to Islam should circumcise. However, the Koran, the primary source of the Islamic law, neither alludes to male nor female circumcision. In addition, classical authors are not unanimous on prophet Mohammad's circumcision. Some think he was born circumcised, others believe an angel circumcised him, yet some say that his grandfather is the one who circumcised him.

Neither of the two biographers of Mohammed, Ibn-Ishaq (d.767) and Ibn-Hisham (d.828) talks of his circumcision. In the 60s and 70s in the US, circumcision was promoted as a way of preventing masturbation. Those opposed to medical benefits of circumcision say that more children die from it that the infections against which it is said to protect. it is also claimed to reduce sexual pleasure. Others look at the practice as mutilating the natural anatomy of God's creation.

In his book, Say No to circumcision, Dr Thomas Rotter writes: " the penis is the most cherished man's physical possession. To admit that it is not, takes a great deal of soul-searching and intellectual honesty." Marilyn Milos, founder and director of the national organisation of circumcision information Resource Centre, US, believes that circumcision is when sex and violence meet for the first time in infants.

Professor Solbak's study (Oslo University) found that cancer of the cervix in females had more to do with penile hygiene than circumcision alone. Evidence has it that most successful rape cases are by circumcised men given the likely trauma on the uncircumcised penis.

The causes to circumcise in order to avoid HIV should therefore bear in mind the fact that HIV/AIDs is very low in Europe where circumcision is rarely practised compared to the US. Whether one is circumcised or not, what matters is the number of sexual partners one has or whether one practise the ABC (Abstinence, being faithful or using a condom) strategy. Since we do not cut off our lips to keep our mouth/teeth clean, I think circumcision to keep off the HIV should be the last resort. Take circumcision when you need it not when you want it.

In The New Vision publication, "Men in HIV Study' of June5, 2006, the writer indicated that Ugandans are among men in seven countries, to get circumcised as a measure to curb HIV infection.

The three-year study carried out by UNAIDS claims that circumcision reduces the risk of contracting HIV by 60%. it is from this study that the debate on adopting this method in preventing HIV infection has taken different dimensions in the health sector. However, the researchers do not say that circumcision does not protect women from HIV. An infected circumcised male is just as likely to spread the disease as an uncircumcised one. The false belief in circumcision may lead to unprotected sex practices as people may erroneously believe that circumcision is like a condom in the ABC strategy, which has been the cornerstone for bringing HIV prevalence rates from 34% in the 1990s to the current 6.4%.

Circumcision was never among the factors for this reduction but rather behavioural change, abstinence and condom use, among others. The message her is, while circumcision may reduce the likelihood of HIV infection, it does not eliminate it!

Look at the Xhosa tribe of South Africa who practise circumcision. If imbalu has not protected the Gisu, what makes Uganda think that circumcision will work here?

In 1999, the American Academy of Pediatrics reversed its position on routine circumcision calling the practice "not essential for the child's wellbeing".

The writer is a medical doctor. He wrote the article with Everest Kizito.

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