Sam Anguria
6 January 2009
opinion
Kampala — IN the recent past, there has been a lot of debate in the media regarding male circumcision as one of the HIV prevention measures.
I would like to contribute to the debate by saying that as a country, we have delayed; we should have embraced it wholesomely when researchers disseminated their findings and deduced that it can reduce infection by 60%.
HIV/AIDS is still an incurable viral infection. There also is no available vaccine yet. In Uganda the HIV prevalence rate stands at 6.4%. A 60% reduction in infection provided by male circumcision should not be taken lightly because it could drop the prevalence rate.
It is ironical to observe that Uganda, which in the early days of the epidemic, was very successful in using the abstinence, be faithful and using condoms (ABC) in reducing the infection from 30% in the 80s to 6% by 2000, is not fast to embrace male circumcision as one of the prevention measures in combating this deadly epidemic.
A blanket of complacency has covered Ugandans and this could be one of the reasons HIV prevalence rate is reportedly increasing.
In 1994, researchers in the US found that with antiretroviral drug AZT, mother-to-child-transmission of HIV would significantly reduce from 25% to 8%.
African countries, including Uganda, who bore the greatest burden of the disease, quickly rolled out the treatment even when it was very expensive.
When it comes to male circumcision, found to reduce infection by 60%, we are reluctant. Why?
As one of the HIV prevention strategies, male circumcision should be fully rolled out in Uganda. A roadmap should be drawn immediately, starting with the development of the male circumcision policy as a guiding framework.
Borrowing from the earlier successes in fighting the epidemic, leadership (political, religious and cultural) is crucial. By leadership, I mean mobilisation of followers as well as walking the talk in as far as male circumcision is concerned.
At political rallies, churches, mosques, burials, clan meetings, male circumcision should be talked about. Leaders should themselves embrace male circumcision and circumcise their male children.
Again, as part of the roadmap, a detailed knowledge, attitudes and practices study is crucial to give baseline information before the rollout. This will also help both the policy makers and activists to find out the myths and ways to address them, including developing brochures of common questions and answers about male circumcision.
Some of the probable challenges with rolling out male circumcision in Uganda would be related to costs (estimated at sh50,000 per operation) and equipment at the health facilities.
The first challenge can be addressed by using those already practicing it, either because of religion (Muslims) or culture (e.g. Sabiny and Bagisu), but with more training on safety. The second challenge could be addressed by government and other development partners prioritising it and apportioning an annual budget to the activity.
Above all, caution should be directed to the population that male circumcision is not the "vaccine" against HIV, but rather one of the prevention strategies.
People have to be told that apart from the known prevention strategies of safer sex, abstinence, freedom from violence, including gender-based violence and empowerment (SAVE), male circumcision is just another and not a complete shield against the deadly virus.
UPDF has done a great job to decimate Kony and his LRA from their bases in the Garamba forest in the DRC by adopting operation "Lightning Thunder". We need a similar operation to decimate the power of HIV and AIDS through male circumcision. We could code-name it Operation Cut HIV.
The writer an HIV/AIDS specialist
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The so-called studies and statistics regarding male genital mutilation called circumcision as being a "prevention" of HIV transmission are flawed, at best, being conducted by individuals who are highly biased by their religious backgrounds for this practice.
At the height of the epidemic in the USA, 80% of males were circumcised, and this certainly didn't prevent the spread of HIV here, and all of the other countries in Europe, Asia, Scandinavia, South America all had much lower rates of infection, the countries that don't habitually mutilate males.
Yet the ones promoting male genital mutilation NEVER address this, the most significant statistic. They never address the complications and lack of sexual sensitivity that results from this needless and barbaric mutilation of the male body.
It is a cultural invasion and incursion to try to impose this practice on others, and some countries are in fact considering legislation to prohibit male genital mutilation aka circumcision, such as Denmark.
The practice of circumcision has declined in the US, as more people discover that a whole penis with a foreskin, which is natural and normal, feels and functions better than one that's been made partial, mutilated and scarred by circumcision.
Every few years they try to come up with another reason for mutilating the penis, years ago it was to try to prevent boys from masturbating, then there was penile cancer, which is indeed very rare, even among non-mutilated men.
There is even some evidence that the foreskin can actually have some anti-viral properties, but biased individuals never research the benefits of the foreskin, they only seek more reasons to chop it off.
How can they explain that the rate of HIV infection in Pakistan is FOUR TIMES that of India, and the rate of circumcision in Pakistan is close to 100% while the rate of infection is extremely low in India, where the vast majority of men are non-circumcised?