Male Circumcision and an HIV free generation

He is part of a small queue that patiently waits to be circumcised at Mutare Provincial Hospital. After receiving counselling from the trained healthcare workers at the health institution, Mupeni is more than ready to undergo the surgical operation.

He comes back after the operation celebrating his newfound passage into manhood. After several regular check ups at the health centre, Mupeni finally completes his last six weeks of healing.

I feel so confident in myself. I believe by getting circumcised and using other various precautious measures, Im safeguarding myself and my faithful partner from contracting HIV infections. I also strongly believe that if all men embrace circumcision it will mark the beginning of an HIV free generation, said Mupeni. Mupenis is part of the 10 111 men who have undergone circumcision in Zimbabwe since the Male Circumcision (MC) policy was launched by the Minister of Health and Child Welfare, Dr Henry Madzorera in 2009.

The World Health Organisation (WHO) offered support to 13 African countries with a high HIV prevalence -Zimbabwe included, which have selected MC to be implemented as part of a comprehensive package of HIV prevention interventions.

The countries which will benefit from this initiative are Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda and Zambia.

Why MC must be practiced

MC is a public health intervention that is provided in approved health facilities in a manner that does not undermine existing interventions, collaborating with traditionally circumcising communities. Statistics derived from studies in countries where MC is traditionally practiced indicated low HIV infections. Solid evidence further highlighted that MC reduces the risk of HIV acquisition was gathered through randomized control trials held in Uganda, Kenya, and South Africa that clearly demonstrates that a reduction of 60 per cent risk in circumcised men.

Technically, this means if Zimbabwe manages to embrace this practice, studies indicates that it will be able to avert almost 750 000 adult HIV infections in the next 10 years if around 50 per cent of men become circumcised. Furthermore the country will be able to save a whooping US$5 billion of medication and operating costs in HIV treatment, counselling, awareness and other affiliated prerequisites.

However, at the moment MC is commonly practiced for cultural, religious and social reasons or due to infections. This group constitutes a mere 10 per cent of men who are circumcised.

Cultural practices

Cultural and traditional practices of MC are evident amongst the Xhosa and Fengu of Ntabazinduna, Tonga of Binga, Venda and the Tshangani of Chiredzi and Mberengwa as part of initiation rites of passage to manhood. These ethnic groups constitute a relatively small size of the national population whilst the majority Shona and Ndebele groups rarely follow the practice.

Efforts are being pursued to reduce new HIV infections, and MC has been identified as an additional and very effective intervention to reduce this alarming number of HIV related deaths. It is against this backdrop that health experts, the parent health ministry, HIV activists and organisations recommended the need to mobilise all men outside the already covered bracket to undergo the surgical operation.

As a result, the MOHCW and its affiliates: National AIDS Council (NAC), Population Services International (PSI), Zimbabwe National Family Planning Council (ZNFPC), UNPF, and WHO, have made tremendous strides in implementing the policy. They have set up a training centre for MC at ZNFPC in Harare and four learning sites at Karanda Mission Hospital in Mt Darwin, Mutare General Hospital, Manyame Airbase and a standalone site in Bulawayo. Both the four sites are now fully operational and learning will be used to scale up services at national level in years to come.

However, medical experts recommended that since MC doesnt provide 100 per cent protection it must offered in conjunction with prevention services and methods, which include abstinence, correct use of protected sex and safer sex methods, sticking to one negative faithful partner, and knowledge of ones status.Dr Madzorera said the primary targeted groups were adult negative males aged between 18 and 29.

This selection was based on two factors, (a) age of peak HIV incident and (b) median age of sexual debut. There is a steep increase in prevalence from age 20 onward, which levels off from the age of 40 years. This suggests that circumcision before the age of 20 confers the greatest benefit in terms of HIV prevention while circumcising men over the age of 40 would result in a relatively low number of HIV infections averted as incidence rates have already peaked. Most importantly the median age of first sex in Zimbabwe is 19 after which a rapid increase in HIV prevalence is observed, thus males are recommended to be circumcised before they become sexually active, though older men are welcome, he said.

In the only study on MC Acceptability in Zimbabwe conducted in Harare (2004), 45 per cent of respondents (male) expressed interest in being circumcised if the practice was confirmed to reduce the risk of contracting HIV or STIs and conducted safely and affordably.

In 2009 more than 2 200 men were circumcised through the pilot sites against a target of 2 000 and the number rose to 6 500 by mid 2010 and currently stands at 10 111. The figure is expected to increase by year end. This has been linked to the 13, 5 per cent prevalence rate recorded this year. Statistics on HIV incidence have indicated that the prevalence rate could be reduced by 25 per cent to 35 per cent if 50 per cent of men are circumcised. The UNAIDS figure for sub-Saharan Africa HIV incidence decreasing by 15 per cent, can be attributed to, among other things, male circumcision.