15 June 2011

Uganda: Mass Male Circumcision Delivers Positive Results

Over the last decade, male circumcision (MC) has been a major intervention for the prevention of HIV in sub-Saharan Africa.

Kenya, South Africa, Rwanda and Uganda, amongst other countries, have taken deliberate measures that ensure mass male circumcision. MC is known to reduce HIV infection risk by 60% and HIV prevalence has been noted to be 5% or less in regions with over 80% MC prevalence. I

t is, therefore, advisable that countries with high HIV prevalence, low MC prevalence, and generalised HIV epidemics should include MC as part of a comprehensive HIV prevention strategy. While MC drives positive health outcomes and contributes to reducing HIV and other sexually transmitted infections, there are skill challenges underlying such interventions. It is no news that the demand for medical workers exceeds the current supply.

Sub-Saharan countries specifically face alarming shortages of human resources for health (HRH) which many times results in life-threatening shortages that contribute to the high morbidity and mortality rates in the region.

In a study by a group of Ugandan surgeons and other researchers titled: The human resource crisis in surgical health care: a survey of district hospitals in sub-Saharan Africa, it was established that many health facilities in Uganda, Mozambique and Tanzania have no surgeons.

Task shifting and task sharing are key strategies that have been utilised successfully in various settings to ensure that patients' needs are met with minimum delays. This means that Middle Level Healthcare Practitioners (MLHP) i.e., more junior medical workers like nurses, medical or clinical officers, are trained to perform or share tasks that would normally be performed by a higher-level trained person like a surgeon.

This has resulted in shortened waiting times for consultations, surgeries and other medical needs - hence bringing much-needed health services closer to the populations. So as to match the supply and demand for MC, countries like Kenya have utilised junior health workers to increase programme productivity. The target for Uganda is to circumcise 4.2 million males in five years.

International Hospital Kampala (IHK) has partnered with the Infectious Disease Institute (IDI) to provide free circumcision at the Namuwongo facility. We currently run MC camps on Saturdays that started in April 2011, and are set to continue till the programme goals are achieved. By task sharing with qualified doctors and nurses, the surgeons have steadily increased volumes by more than 250% since the camps started.

The outcomes so far have been very successful and more than 1,000 male adults have benefited from this free programme over an eight-week period. One of the beneficiaries, Samuel Kasule, 29, feels that the camp could not have happened at a better time.

"I wanted it [circumcision] a long time back but I was told I would take long to heal. Now that I've done it, I am pleased that I resumed work by the third day and I am now healed after 10 days."

Dr Moses Galukande, the Programme Director for these camps and co-author of the aforementioned research paper, explains: "There has been an overwhelming response which is very pleasing and, hopefully, people fully understand the benefits and the limitations of safe male circumcision."

Mass MC is fundamental to the prevention of HIV in sub-Saharan Africa. It is, therefore, critical that alongside condom use and other measures, effective mechanisms for delivery of MC services are adopted. Demand creation through sensitisation is important so as to encourage health-seeking behaviour. The advantages of MC must be well understood by adult males so that they make an informed choice.

Men who choose to circumcise find it easier to keep the penis clean and maintain hygiene. There is also reduced risk of HIV or other STIs (e.g., syphilis, genital warts, and herpes), reduced risk of penile cancer and reduced risk of cervical cancer to female sexual partners.

Prior to their circumcision, beneficiaries from the circumcision camps at IHK are educated on the MC process through counselling, advised on care needed during the healing process, and counselled on safe sexual behaviour and family planning. They are screened for STIs, and treated if found necessary. MC does not in anyway relegate other safe sex measures, such as condom use.

Plans are underway to expand this exercise to 10 other sites in rural and peri-urban areas in a bid to upscale MC.

The author is Director of Human Resource and Communications at International Hospital Kampala (IHK).

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