As the influential leader of Zambia's Kaonde people, Chief Jonathan Eshiloni Mumena's decision to undergo male circumcision was nothing short of a public health practitioner's dream. Since undergoing the procedure two years ago at the age of 47 and breaking with tribal custom, Chief Mumena not only kicked off a vibrant discussion about circumcision's role in HIV prevention, but he got men - by the thousands - to act.
AllAfrica first spoke to Chief Mumena last July at the International Aids Society Conference in Washington, DC. We checked in with him again to learn how he is continuing to spread his message and what challenges lie ahead.
You've been traveling around Africa to get people to understand the benefits of male circumcision to help stem HIV transmission. How has that been going?
So far, so good. I realized that there was something we needed to scale up - the uptake of male circumcision and create demand as a way of finding a solution to the HIV/Aids pandemic and to discover that HIV/AIDS is across all cultures and therefore cultures are trying to find a lasting solution. We still do not have a cure so we need to take practical steps, and one of those practical steps is male circumcision.
Is there a particular country or region that needs the most work to progress regarding male circumcision?
East Africa and southern Africa - these two regions need a lot of help, a lot of scaling up. They have a lot of work to do because they are the epicenter of the HIV/Aids pandemic. So this being an epicenter, we need to find means and ways and perhaps think outside the box to see how best we can bring about innovations to respond to the pandemic.
You took a bold step as a leader being one of the first in your community to do get circumcised. How do you find other traditional leaders respond when you discuss this?
After I took the step that I did, then I realized many others wanted to find a way of resolving this issue. As I went public about the issue, and remember that I am from a non-circumcising tribe, and therefore there were issues on how best we were going to do that [go public], especially because I was a traditional leader. I'm a custodian of custom and culture and therefore male circumcision not being one of our practices means that you're challenging the powers that be, challenging the history, challenging who we are as a people.
But after going public about it, one thing I realize is that every culture today is threatened by HIV and Aids. And therefore, it is necessary that we as leaders, even those from the non-circumcising [tribes], must be able to look at this and find a practical solution.
And male circumcision is one such practice. As a result of that, I've been talking to the village communities, the men and women, and also to the traditional leaders from other cultures that are non-circumcising and even from those who are circumcising so they can be able to share their secret. In Zambian regions like northwestern province and eastern province, which have circumcising tribes, you will also discover that the prevalence rate is very low. Perhaps we can suggest that male circumcision - where it has been practiced whether traditionally or otherwise - has been helping to reduce the incidence of HIV/Aids.
I've been talking to many others and thankfully I think that we've been scoring a lot of successes and many other chiefs are coming on board and influencing communities. Others have gone public about it, others are doing it quietly, but you see that the impact is there. Not only in the traditional areas. We've reached the people in the urban setting by radio and TV programs and adverts and taking the discussion there and also making sure that people phone in on the [national] toll-free line 990 to be able to ask their questions. So I think that whether it's at the traditional level or in the urban setup, the message is running like wildfire.
You did got circumcised in 2011 and said that August has become "male circumcision month" in Zambia. Have you been surprised at how quickly that has caught on?
I must say I was shocked because I didn't know the response was going to be so good and so big. I didn't realize that so many people - they may not talk about it publicly - have actually been trying to find solutions.
So when I went on TV with the help of Society for Family Health, we carried out these interviews and adverts. In August 2012 when we thought we were targeting about 30,000 people nationwide [to get circumcised], by the end of August 2012, we were already at 37,000. So by popular demand, we had to extend the period into September 2012. By the end of September, we were already at 68,000. And it has been like that since then. Every day we have people queuing up.
I think what I look forward to is a situation where the male circumcision services are provided every day and everywhere, just like we do for under fives and antenatal. I think we need to reach a stage where male circumcision services are provided that way. Notwithstanding, I am aware that we have challenges with personnel, human resources and facilities. I look forward to a moment when anybody can walk to a health centre any time and be able to say, 'I demand to be circumcised', and they should be given that opportunity.
And at the same time, just as much as we have HIV/Aids corners, we also need a reproductive health corner, which looks at reproductive health, motherhood, male circumcision, information for cancers, cervical cancer, voluntary counseling and testing so that we are the one-stop-shop for all these programs. I think above all, when we look male circumcision, we have mostly the policy in Zambia where one goes through surgery but I think there's a need to scale up most of these other services, so that we can also provide it through the PrePex http://www.prepex.com/and other tools that are coming on the market.
This is going to help us as we fight the stigma, but one can use the PrePex for instance and still go about their business. They don't need a service provider. So where we have challenges with health providers, gadgets like the PrePex could ensure that the men could go ahead and do it on their own.
So I think that the future looks very bright. And I can see that once this becomes part and parcel of our culture, I'm looking forward to the day when we'll say bye to HIV/Aids.
Jaclyn Schiff spoke to Mumena in Zambia on a trip sponsored by the International Reporting Project, which receives funding from the Bill & Melinda Gates Foundation.
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From a USAID report: "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher." http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
It seems highly unrealistic to expect that there will be no risk compensation. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms". http://www.info.gov.za/issues/hiv/survey_2009.htm
It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/a bstract ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.
A man with foreskin shared his experience on the sensations of orgasm.
“When pressed for details, my [circumcised] friends described ejaculation as something that felt good for the penis, and pleasure that lasted for about 5 seconds after a while masturbating with lotion.
For me, this experience was (and still is) vastly different. My friends described the sensations of orgasm as something limited to the penis. For me, orgasm was something that not only felt good for my penis, but also felt good for my entire body. Orgasm for me is not some sudden surprise coming, either, but rather something I can feel coming on from the very moment I begin making love. And even when the moment comes, orgasm for me is peak to a gradual and fulfilling crescendo of sexual pleasure, where it reaches an apex after I ride waves of pleasure up and down, and slowly wind down enjoy the aftermath of that feeling.
It is like all of the pleasure that comes from my penis when I ejaculate being multiplied by a factor of 5, and having this intense pleasure everywhere in my entire body at once for about a whole minute, leaving me writhing, and convulsing in ecstasy as I climax. It feels like my entire body is tingling—from my toes, up and down my spine, all over my back, chest, abs, and groin, and all the way to the top of my scalp, leaving my body gently convulsing (sometimes shaking) in pulsing ecstasy. (During this time, I also happen to ejaculate.) And afterward, when my penis begins to become flaccid, even the slightest touch on my penis feels really good, and takes my breath away in a really good way.
This was vastly different from what my friends described, which to me sounded like about 10 minutes of work for 5 seconds of sudden pleasure, followed by boredly staring down at the penis, quickly taking the hands away, and waiting for it to go down (because touching the glans right afterward hurts them for some reason).”
IT IS OUR AFRICAN CULTURE AND WE "AFRICANS AND AFRICA" ARE BOUND TO GO WITH IT THROUGH OUT AFRICA. THE DAYS OF LOOKING UPON AFRICANS AND AFRICA AS KIDS IS OVER ON THIS EARTH. WHAT IS AFRICAN AND AFRICA WILL BE PRACTICE BY AFRICANS AND AFRICA REGARDLESS WHAT THE RACISTS AND NEGATIVE INDIVIDUALS OF THE WORLD IS THINKING OF. CIRCUMCISION WILL PREVAIL IN AFRICA; AND BESIDES OUR AFRICAN CULTURES, TRADITIONS, NORMS, VALUES, SOCIETIES OR ANY OTHER IS/ARE VITAL AND VALUE AS ANY CULTURES IN THE WORLD.