Sensitisation needed prior to circumcision

Jan 14, 2009

I read Hillary Bainemigisha’s article on mass male circumcision entitled “Circumcision for all in 2009”, published on December 20, 2008, with a lot of interest.

By Joseph Matovu

I read Hillary Bainemigisha’s article on mass male circumcision entitled “Circumcision for all in 2009”, published on December 20, 2008, with a lot of interest.

Bainemigisha quotes Dr Alex Opio, assistant commissioner for National Disease Control in the Ministry of Health, as saying the Government plans to introduce free mass circumcision before the end of 2009 as one of the ways to reduce HIV spread.

Recent research conducted in Uganda, Kenya and South Africa indicated that medical male circumcision can protect HIV-negative men from the risk of HIV infection by up to 60%.

This is good ground to argue for medically performed adult male circumcision in a country whose HIV prevalence has stabilised between 6.1-6.5% since 2000, and where the percentage of circumcised men in traditionally non-circumcising communities ranges between 8-40%.

The good news is most men and their partners favour circumcision, citing medical, hygiene and sexual-related reasons.

In a recent needs assessment conducted by Family Health International and the Ministry of Health to determine the acceptability and feasibility of male circumcision promotion in Uganda, between 40-62% of uncircumcised men interviewed reported that they would be willing to accept male circumcision if it was offered to them.

Females interviewed as part of this assessment emphasised the role that male circumcision would play in improving men’s penile hygiene as well as reducing the incidence of sexually transmitted infections. These findings suggest that male circumcision is a welcome intervention in the fight against HIV in Uganda.

With this high level of acceptability, there is no doubt that many men out there will be willing to be circumcised. However, the promotion of adult mass male circumcision must take into account the fears in the population that circumcised men might become more promiscuous than ever before: “I think circumcision increases promiscuity. Sitting at the market here daily, I observe many young men get circumcised and nursed at the mosque across from here but as soon as they get better, I see them go after every girl around” intimated one of the women interviewed in Gulu district as part of the above-mentioned needs assessment.

Because of these concerns, circumcised men and their partners should be strongly encouraged to continue to protect themselves from the risk of HIV infection through available prevention strategies. These strategies include abstaining from sex altogether, limiting sexual activity to one partner who is HIV-free and who has no other partners, or correct and consistent condom use in other circumstances.

Based on available evidence, circumcised men should abstain from sex until the wound has been certified as healed by a health worker to avoid any infections that may gain entry into the body via the wound, including HIV and other STIs.

That is why it is important to sensitise men about the need to wait for up to six weeks before resuming sexual activities following male circumcision.

However, research conducted in Rakai suggests that between 14-17% of circumcised men resumed sex within 2-3 weeks of undergoing the procedure, suggesting that some men just can not wait any longer to resume sex following circumcision, however risky such early sex resumption might be. Cases of women luring men into resuming sex before the wound is completely healed have also been documented.

In some cultures, there is even a belief that vaginal fluids have healing properties for the freshly circumcised penis: so, men resume sex early to enhance the healing process! Such misperceptions would need to be addressed if the preventive benefits of male circumcision have to be enjoyed.

Finally, it is important to remember that medical male circumcision does not automatically protect women from acquiring HIV. So, women should still insist on protected sex with their male partners. And, in order for medical male circumcision to yield the desired protective effect, a significant portion of adult males would need to get circumcised. Circumcision of a few scattered individuals will not give us the change we need.

Given these arguments, it is important that the Ministry of Health conducts mass sensitisation campaigns throughout the country to educate people about the benefits and limits of male circumcision, including the fact that male circumcision works best when used in combination with other existing HIV prevention strategies.
The writer works with the School of Public Health at Makerere University

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