Government starts talks on circumcision

Feb 20, 2007

THE Ministry of Health has started talking to stakeholders as one of the procedures for drafting a policy on circumcision. This followed a survey on circumcision in Rakai district recently which recommended that developing countries should widely adopt male circumcision as an HIV prevention method.

By Irene Nabusoba

THE Ministry of Health has started talking to stakeholders as one of the procedures for drafting a policy on circumcision. This followed a survey on circumcision in Rakai district recently which recommended that developing countries should widely adopt male circumcision as an HIV prevention method.

The studies, under the Rakai Health Sciences Programme revealed that the procedure reduces the risk of new HIV infections in men by over 50%.
Similar studies were also carried out in South Africa and Kenya.

“Our findings show that circumcision was able to prevent about 50% new infections in HIV-negative men. Circumcision should, therefore, be added in our armament for HIV prevention,” Prof. Ron Gray of Johns Hopkins University, Baltimore said.

“Circumcision offers prolonged protection, is cost effective and has very optimal utility to the public because it prevents infection in men, hence protecting their wives and consequently avoiding mother-to-child transmission infections,” Gray added.

The advocacy for circumcision started when a study done in South African revealed that for every 10 uncircumcised men that contracted HIV, three circumcised men got infected.

Researchers consequently demanded that circumcision be widely adopted as an HIV prevention method, but the World Health Organisation and UNAIDS refused to endorse it until the studies produced successful results. Both studies have been concluded with impressive results.

Dr David Serwadda, who led the four-year study, said they enrolled 5,000 men between the ages of 15-49 years. Half of them were randomly asked to be circumcised, the other half served as an intervention group remaining uncircumcised. These were monitored till December 12, 2006 when the studies were halted.

“Additional data is unlikely to change anything,” Serwadda says.
He explained that 90% of the protection is due to removal of the foreskin. “The foreskin is vulnerable to tears and ulcers that provide an entry point for the HIV virus.

The inner mucus also has high density to accommodate HIV because the mucosal layer does not have keratin,” Serwadda said. Keratin is a tough, insoluble protein substance in the skin, hair and nails. When it develops on the penis head, it protects men from HIV penetration.

He, however, warned that the circumcision policy should be implemented very carefully.
Dr. Sam Watya, a eurologist from Mulago Hospital, said according to the Ministry of Health standards, only doctors and clinical officers can conduct circumcision. “It is only Health Centre 4s and district referral hospitals that, on average, can conduct circumcision.”

“Circumcision looks simple, but it can still pose some complications, especially when done on adults whose blood vessels are bigger. We must prevent amateurs from doing it,” Watya cautioned.

About the policy, Dr. Sam Okware, the commissioner health services, said: “We must avoid rocking the boat by diverting resources and giving double-edged messages to the public. We need to integrate it. We need to train personnel, especially midwives, nurses and cultural people who have been carrying it out among Muslims and tribes which practice circumcision,” Okware said.

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