Southern Africa in Circumcision Drive to Curb AIDS Spread

by VR Sreeraman on Jul 17 2010 2:54 PM

 Southern Africa in Circumcision Drive to Curb AIDS Spread
Thomas Mukone wonders exactly how he would tell his wife that he wants a circumcision at age 41, even with the government in Zimbabwe urging adult men to get snipped to slow the spread of AIDS.
"It's not easy to discuss this as she is bound to accuse me of promiscuity," he said. "It is a really nice programme, but how will I tell my wife that I want to go for circumcision?"

Zimbabwe has joined the growing list of countries in southern Africa that is pushing, and sometimes paying, for adult men to get circumcised, in the wake of studies that found men without a foreskin are 60 percent less likely to catch HIV.

Scientists think this is because the foreskin has more cells that are easier for HIV to infect. The findings have sparked a regional drive to make circumcision a routine party of prevention efforts.

Zimbabwe aims to have 30,000 men undergo circumcision by year end, said Owen Mugurungi, head of the national HIV prevention programme.

It's an ambitious target -- 82 men would have to get trimmed every day in a country where the medical service struggles to provide basic care.

Mugurungi said 4,000 men have taken part so far, including many in the army, and donor funding means the procedure is free for volunteers.

But convincing men to undergo the procedure requires tackling issues both complicated and intimate in the region hardest-hit by AIDS.

"In many households, the issue of circumcision is still treated with suspicion and we need to do more campaigns" to educate the public, Mugurungi said.

Trials in Kenya and Uganda have shown that circumcision, while far from being a silver bullet, dramatically reduced the number of new infections for men.

Uganda, a pioneer in HIV prevention, is currently running television and radio campaigns to encourage men to visit clinics for safe circumcision procedures.

Botswana has launched a scheme to circumcise 500,000 men -- a quarter of the total population -- by 2012.

Zambia, Lesotho and Swaziland all encourage circumcision as a matter of policy, and South Africa is running a pilot project to offer free circumcisions.

Each country is facing its own hurdles.

In some communities, circumcision is practised as a rite of passage for teenage boys. Xhosa boys in South Africa are taken to initiation schools where their foreskins are cut by traditional doctors of varying competence.

Every year, dozens of boys die of complications from the procedure, while scores more suffer amputations or gangrenous infections. That can scare off potential volunteers from safe medical circumcisions performed in clinics.

Zulus abandoned the tradition more than a century ago, but their king has proposed reviving the practice to fight HIV, with trained medical staff doing the work.

In countries like Swaziland, where HIV infects 26 percent of adults, circumcision trials began five years ago and worries have already sprung up that after the procedure men see less need to use condoms, creating a new HIV risk.

Still, the country is aiming to circumcise 80 percent of men aged 15-24 over the next four years.

The question remains, will the men participate?

Malawi has refused to look at circumcision as an option, saying it is too difficult culturally for people to accept.

"Malawi is not a circumcised country, so circumcision cannot work," said Mary Shawa, head of Malawi's AIDS and nutrition programme. "It's very difficult to implement as a policy."

Still, across most of the region billboards are sprouting up like those in Zimbabwe, which show five footballers forming a wall in front of the goal line, under the message: "Male circumcision is one of the top defenders against HIV."

Admire Murerwa, 21, a street vendor selling his wares a few metres (yards) from the sign, is not convinced.

"Yes, circumcision is right," Murerwa said. "I still think the condom is better to reduce HIV infection. Circumcision is right, but it also depends on how one behaves for you not to be infected."