From a select number of previous stories, South African maternity clinics can be inhumane towards migrant women and the nurses can be merciless towards such clients, yet those health institutions administering especially Voluntary Medical Male Circumcision have managed to attach a human face to this otherwise anti-migrant set-up.
A brief study by this reporter recently showed that VMMC – one of the most cost-effective and yet still one of the most reliable ways of preventing the AIDS scourge (can prevent female-male transmission of HIV by up to 60 per cent) is – unlike other free basic services, highly-inclusive of even those migrants who lack proper documentation, and that those who haven’t done it yet cannot be victims of a brutal system.
We include all foreigners in our services and you do not have to be a South African Citizen to obtain the free service. Â We do however need some form of age verification as we are not allowed to perform VMMC on men younger then the age of 10. Â We have not worked with specific organisations, but we include communities where mostly foreigners live in our outreach.
Johannesburg-based Bongiwe Klaas of the Centre for HIV/Aids Prevention Studies (CHAPS) confirms – albeit without specific figures, that SA’s HIV prevention measures know no nationality.
“We do not have data on this as we do not record if a patient is a SA citizen.  Anecdotally, we know that in communities where there are large numbers of foreigners our outreach activities are quite successful,†says Klass. CHAPS – a South African public benefit organisation, is a leader of one of the largest VMMC scale-up programmes on the African continent.
According to its website, the organisation takes pride in its pioneering work in VMMC Service Delivery, VMMC Training, HIV Research and VMMC Start-Up Technical Assistance. It is not recorded how many migrants have undergone VMMC procedure in South Africa, but Klass says that is mainly because service providers do not discriminate and therefore, do not have a separate register for migrants and locals.
“We include all foreigners in our services and you do not have to be a South African citizen to obtain the free service.  We do however, need some form of age verification as we are not allowed to perform VMMC on men younger then the age of 10 years.  We have not worked with specific organisations, but we include communities where mostly foreigners live in our outreach.†Gabriel Philip Sibanda is one of those migrants who underwent a VMMC operation in South Africa a few weeks ago. “I was referred by a friend and fellow Zimbabwean who did the operation before me,†says Sibanda, who holds an asylum seeker permit.
“I had initially been hesitant of going there, thinking I would be putting myself in the trouble I went through when I applied for my asylum seeker permit, but the friend, who does not have documentation, told me that the situation was different and that operation was not as painful as I had thought, so I decided to do it in late May.†The warm reception that Sibanda and three colleagues he went with got when they did the operation at Hillbrow “General†Hospital was overwhelming. “It gave me a different feel of the South African health system. Everyone there was friendly and handled both South Africans and foreigners with warm hands. If it was possible, I would do that every year,†he quips.
“The pre and post-operation counselling was a highlight as officials told us that all they cared about was protecting us from the killer disease, yet stating clearly that this did not mean we should be reckless afterwards, as it was still possible to get HIV even after the operation. “I will not throw my life on the line by risking, but I am personally glad that I have done it. I have successfully referred five more Zimbabwean friends and they all speak highly of the reception they got.â€
Another Zimbabwean, Prisca Ndlovu, whose 13-year-old son was clinically circumcised in early June, also spoke highly of the system. Klass says age is a problem when it comes to dealing with migrants though. “The biggest drawback is the age verification.  We do know that foreigners are often suspicious of coming to the clinics, but we do our best to overcome this and I am sure it’s the same for the other NGOs performing VMMC. We are all under pressure to perform the maximum number of VMMCs we can per month,†adds Klass.
“We need some form of documentation to verify the age, but people are suspicious and careful not to show identification in fear of being exposed.  Our Outreach staff, nurses and Doctors are trained to make sure that they make all patients feel safe and cared for, especially to make foreigners feel that we won’t expose them.  But of course some suspicions will remain.â€
South Africa is one of the 14 countries in Southern and Eastern Africa that have initiated programmes to expand the provision of male circumcision, following UNAIDS’ 2009 recommendations of VMMC as a key component of HIV prevention in countries with high HIV prevalence and low levels of male circumcision.
Other such countries are Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. CHAPS has been central to the roll-out of VMMC in South Africa. In 2010, following successful VMMC trials, the organisation was established in Orange Farm, a migrant-laden township outside Johannesburg, to contribute to the roll-out of South Africa’s national VMMC programme.
However, because the SA healthcare system was still struggling to cope with the rapid expansion of antiretroviral treatment and a chronic shortage of health workers, CHAPS and the National Department of Health selected private sector clinics in high priority areas and trained private providers to deliver free VMMC.
Between 2012 and 2015, CHAPS trained and partnered with 12 private practitioners and about 250,000 circumcisions were performed by CHAPS, with private practitioners accounting for close to 60,000 of that total.
Post published in: Featured
Male circumcision is a dangerous distraction in the fight against HIV/AIDS.
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.”
(this will include men who were circumcised tribally rather than medically, but they and their partners may also believe themselves to be protected, and the whole rationale for the RCT’s into female-to-male transmission was a purported correlation between high rates of male circumcision and low rates of HIV)
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”. This figure seems to have been unchanged in 2012.
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:
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.
Claiming that circumcision prevents a health problem is a compulsion of circumcised men to have done to others what was done to them. Historically, this compulsion has led to over 200 potential health claims for circumcision. All have been refuted. Thirteen national and international organizations recommend against circumcision.
Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. The investigators did not seek to determine the source of the HIV infections during their studies. They assumed all infections were heterosexually transmitted.
Many HIV infections in Africa are transmitted by contaminated injections and surgical procedures. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Even if the claim were true, based on the studies, about 60 men had to be circumcised to prevent one HIV infection.
Authorities that cite the studies have other agendas including political and financial. All other national and international organizations that have positions on circumcision oppose it. Research shows that circumcision causes physical, sexual, and psychological harm, reducing the sexual pleasure of both partners. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Even HIV/circumcision studies advise using condoms. With condoms circumcision adds no benefit to HIV prevention.
Circumcision will not be “voluntary” when it is forced on children.
In terms of male circumcision based on what some people here said, most who actually just troll and spam same things everywhere. The WHO is a very reliable organization thats recommends considering circumcision as part of a comprehensive HIV prevention program in areas with high rates of HIV. Circumcision in general is associated with reduced rates of cancer causing forms of HPV and risk of both UTIs and cancer of the penis. Risks rates are usually very very low and only higher when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age. Circumcision does NOT have a negative impact on sexual function or psychological by multiple studies. Most reliable studies show there are benefits and negative effects are rare or just not backed up by reliable sources. There are lots of anti-circumcision trolls who spread misinformation here. Look at most objective studies and they show benefits.