Myths and fears about VMMC

Fears and myths about Voluntary medical male circumcision (VMMC) are greater for some men than getting HIV, and are slowing efforts to circumcise men in Uganda.

Rumors that exaggerate the pain and injury posed by the procedure, suspicions about its association with other cultures, and questions of potential costs have kept some men in western Uganda from going for voluntary medical male circumcision, which the Ministry of Health recommends as a way to significantly reduce the risk of HIV infection.
 
‘I have heard some people in my village saying that circumcising old men leads to a terrible disease called tetanus which can kill a man in very few days'. Says Jackson Mftimukiza from Nyarusiza in Kisoro district.
 
The fear is not entirely without substance, but may be overstated. There have been reports of deaths from tetanus of men who had been circumcised. According to the Ministry of Health, in 2014, five males developed tetanus after undergoing the procedure. The cause of the infections was not clear, but was most likely due to a failure to seek medical attention and follow-up care, and a lack of immunization against tetanus. The Ministry of Health is now requiring men who want to be circumcised to be vaccinated against tetanus a month before the surgery.

At 24 years of age, Mftumukiza says that he has heard a program on FM radios in Kisoro advising men to go for voluntary male medical circumcision (VMMC) but he has not made a decision to go for it yet.
 
Cultural misunderstandings about circumcision can also get in the way. Traditionally, circumcision was not done in Mftumukiza's family and members of his religious group.

‘I was born a Catholic, and you know how Catholics are rigid. When I tried to ask my father about the issue of circumcision, he did not even give me a minute to explain what I had heard on radio. He only told me that he would not accept me to become a Muslim.'

Money issues

The healing period that follows medical circumcision can present a challenge as well.
 
Some men are refusing to go for circumcision because they believe that spending six weeks during the healing process will make life difficult for their families since they are the only breadwinners in their families.
 
‘When I circumcise, I will spend a lot of time without working and they are not going to feed my family'. Mfitumukiza continues.

James Aturinda from Kisenyi, in Mbarara shared this concern, ‘When I went to the hospital to get circumcised, the doctor told me that I will spend six weeks during the healings process and will not be working and yet I am the only one working for my family the rest are my dependents; So when I heard that, I had to refuse the procedure because my children and my whole family would starve.'

Other fears
 
Then there was the idea of giving up sex during the healing period after the surgery that puts some men off VMMC. ‘I cannot imagine spending six weeks without sex with my wife while sleeping with her every day, I tell you it is very difficult, this is why I am failing to gather enough courage to go to hospital and have the procedure done on me,' says Fortunate Tuhimbise, from Fort Portal.
 
Despite reassurances to the contrary, he also suspects that circumcision may interfere with his ability to enjoy sex. ‘I have also heard that the drug that causes men not only tofeel pain during the cutting of the skin. It goes on to prevent the penis from feeling at all!,' Tuhimbise worries. ‘I therefore cannot risk losing my sensation, I can rather remain with my skin and be careful than never feeling anything during sex.'
 
For others, it is a concern about how long a partner is willing to go without sexual relations.  

‘To be sincere I don't trust my wife, I doubt that my wife can remain without sex for six weeks while I am healing. I know her, she has some men who disturb her demanding for sex when I am with her and my penis is okay, what about if those men hear that I went to circumcise?, they will use the chance to seduce my wife, I can't take that chance'. Adds Jackson Mbaita, from Nyakijumba, in Kabale district.
 
Still others have questions about what happens to the foreskins once it is removed.

‘I want to remain with my fore skin because I have heard that some health workers are paid to give the fore skins to witches who later use them to make men impotent. I therefore cannot accept to lose my manhood,'according to Deus Nsabimana from Kisoro.
 
What is the truth?

Dr. Barbara Nanteza, the national coordinator of VMMC in the Ministry of health, says all these myths and fears are unfounded and should not keep men from doing the one thing that has been scientifically proven to help with HIV prevention. Though the myths are more prevalent in some regions of Uganda than in others, she says they are widespread throughout the country.

The government has a program called Obulamu to promote healthy sexuality that is designed to dispel these myths, but she acknowledges that it has not been very successful. Dr. Nanteza says more needs to be done to overcome these barriers.

'VMMC reduces a man's risk of acquiring HIV from a female partner by up to 60%. Men should therefore go out and visit all hospitals near them where the service is offered in order to significantly reduce their chances of acquiring HIV,' says Dr. Nanteza.
 
According to UNAIDS, the most recent data from Uganda shows that in the five years since the Uganda trial was completed; high effectiveness has been maintained among the men who were circumcised, with a 73% protective effect against HIV infection.
 
Dr. Emmanuel Byaruhanga, the director of Kagongo Hospita, Ibanda says that over 10 men were being circumcised per day at Kagongo Hospital Ibanda during USAID STAR program but declined after the program ended.
 
He adds that there are many advantages of VMMC which include the following:  Getting rid of the wet, warm and dark environment under the foreskin that can sustain viruses such as HIV and other sexually transmitted infections such as syphilis, herpes and cancroids; Reducing the female partner's risk of cervical cancer; It not only reduces the man's HIV and STI risk but also his partners'; It does not affect men's sexual drive; Women report better performance by circumcised men and it is 100% cleanliness.
 
The VMMC intervention for HIV prevention is currently being done in: Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.
 
WHO and UNAIDS recommend that VMMC for HIV prevention offers excellent value for money. Recent modelling studies found that reaching 80% coverage among men 15 - 49 years old in the priority countries - by performing approximately 20 million circumcisions - would cost US$1.5 billion and would result in net savings of US$16.5 billion by 2025 due to averted treatment and care costs. Achieving, and maintaining, 80% coverage through 2025 would avert 3.4 million new HIV infections.