Kakaire A. Kirunda
26 March 2008
Kampala — THE government will only come up with a national policy on medical male circumcision as one of the measures to minimise HIV infection after consulting widely.
Medical male circumcision is done in hospitals by medical officers as opposed to traditional circumcision.
This was disclosed by the Assistant Commissioner for National Disease Control in the Ministry of Health, Dr Alex Opio, during a public debate on safe male circumcision for HIV prevention held at Hotel Africana yesterday.
The debate was organised by the Makerere University School of Public Health and the Association of Surgeons of Uganda.
"We are just taking a cautious approach but the ministry has already embarked on consultations with all the stakeholders," Mr Opio said.
"We need to address a number of issues that come with a massive circumcision programme." The call for a policy from public health experts has been on since the December 2006 announcement of research findings in Uganda, Kenya and South Africa that found that circumcision reduces, by 60 per cent, the chances of males acquiring HIV.
According to Dr Opio, one of the issues for consideration is that of cultural and religious sensitivity towards circumcision.
"For instance among the 15 to 49 year old men, only 24 per cent are circumcised. The majority did it for cultural and religious purposes," he explained. "So if we are going to make it a policy, the non Muslims should not look at it as if we are imposing on them Islam."
He said once the consultations are finalised, the government would launch medical circumcision as one of the components of the wider HIV prevention strategy that also includes ABC [Abstinence, Being faithful and Condom use] among others.
Dr Stephen Watya, a senior consultant surgeon at Mulago Hospital said several challenges stand in the way of massive circumcision. He said currently only medical officers are allowed to carry out circumcision, saying this is a hindrance.
Financial resources and theatre infrastructure were also pointed out as obstacles that need to be addressed.
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Circumcision can only possibly help men who have unsafe sex with HIV+ partners, so why this bizarre obsession with genital surgery when we know that ABC works better than circumcision ever could? (ABC=Abstinence, Being Faithful, Condoms). The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circed men than intact men, yet they've just started a nationwide circumcision campaign. Something is very wrong here. These people aren't interested in fighting HIV, but in promoting circumcision, and their actions will cost lives.
Female circumcision seems to protect against HIV too btw, but we wouldn't investigate cutting off women's labia, and then start promoting that.
When Uganda is considering its policy on promoting circumcision to combat AIDS it would be prudent to consider the implications of a mass circumcision program.
Firstly, the most that can be said for circumcision is that it reduces the chances of a man catching HIV and perhaps some other infections. It does not eliminate the risk completely. Campaigns that promote safer sexual practices and the use of condoms have a good track record in bringing down HIV infection rates in communities. It would be a tragedy if proven methods of HIV control were replaced by this one intervention.
Secondly, whatever advantages may be claimed for circumcision, it is inevitable that some men would not be prepared to have this procedure. Doctors and governments may recommend, but it is for the individual to decide whether he wants to be circumcised or not. in Rwanda, the BBC News reported: “The program will be voluntary, but those in the army likely will see circumcision promotion as an order.” ‘Rwanda Launches Male Circumcision Campaign To Help Reduce Spread Of HIV,’ Medical News Today, 25 January 2008 Compulsory circumcision means forced circumcision, and this would be a human rights violation and quite counterproductive.
Thirdly, while medical circumcisions might be relatively safe, circumcisions performed by untrained operators are not so. A circumcision drive is likely to attract the some shady characters who will prey on the unwary. Untrained operators may actually spread HIV rather than preventing it. The public needs to be warned against untrained operators.
Fourthly, newly circumcised men may be more vulnerable to HIV until the wound completely heals. Men need to be warned about this fact.
Male circumcision might reduce the chance of HIV infection but it is far from a magic bullet. A gung-ho approach to spreading circumcision is bound to cause serious problems; a softly, softly approach, with continued emphasis on proven methods of HIV control: Abstinence, Be faithful and Condoms, is likely to be far more effective.
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