21 April 2017

Swaziland: Swazi Circumcision Drive Failing

As the discredited campaign to circumcise men in Swaziland to prevent HIV infection continues to fail, two government ministries are now targeting schoolboys.

A Back to School 2017 campaign has been launched in by the Ministry of Health and the Ministry of Education in partnership. It aims to help get 80 percent of Swazi males circumcised by 2022. Schoolboys will be 'sensitised' to the supposed-need to have their foreskins cut off to prevent HIV infection.

The target that 80 percent of Swazi males between ages 15 and 49 should be circumcised was made in 2010 when the Accelerated Saturation Initiative (ASI) was introduced into the kingdom with the aim of reaching the goal within a year.

The programme, a partnership between the Swazi Ministry of Health and Social Welfare and the US-based Futures Group, was then extended to March 2012 when initial efforts failed to achieve the targeted results and only about 20 percent - or 32,000 - people were circumcised through the programme. The figure for the number of males in the targeted age range is not easily available but there are estimated to be 384,171 males aged between 15 and 65 in Swaziland.

US$15.5 million was spent on the programme, or US$484 per circumcised male.

In 2015, the deadline to reach the target was extended to 2018. Now, that deadline has been extended further to 2022. The Swazi Ministry of Health reported 96,487 males had been circumcised since 2009.

The male medical circumcision programme which has been introduced in a number of countries in Africa, but not in developed countries such as the United States or in Europe, is based on a claim that removing the foreskin helps to prevent the spread of HIV. However, evidence does not support this.

A report called Levels and spread of HIV seroprevalence and associated factors: evidence from national household surveys published by USAID, for example, which studied 22 developing countries, primarily in sub-Saharan Africa, found, '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.

In Swaziland, even before the ASI was started in 2010, the Government of Swaziland knew circumcision had no effect on the rate of HIV in the kingdom. The Swaziland Demographic and Health Survey (SDHS) of 2007 reported the infection rate for circumcised males was 22 percent while for those uncircumcised it was 20 percent, which suggested that circumcision did not prevent HIV spreading.

The Swaziland Government has signed up for circumcision in a big way since 2010, even announcing that newly born babies, who have no say in the matter, were expected to be cut.

People in Swaziland are being misled into believing that circumcision can help, when the international medical community continues to debate whether there is any evidence that it can. An internationally-based organisation called Doctors Opposing Circumcision (DOC) published a lengthy report in which it urged that 'Both the public and the medical community must guard against being overwhelmed by the hyperbolic promotion of male circumcision.'

DOC reported that there is no clear evidence as to the effects of circumcision.


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