Uganda health experts’ assessment of male circumcision

More than 600,000 Ugandan male have been circumcised since the Safe Male circumcision policy was introduced in Uganda in 2009 to consolidate the fight against HIV/Aids.
Dr Jacinto Amandua, the commissioner clinical services in the Ministry of Health, who is also part of the National Task Force of Male Circumcision, says the target of the ministry is to circumcise four million male by 2013. He adds that this programme stands until the HIV/Aids prevalence rate is down to zero.

Current statistics show that the HIV/Aids prevalence rate amongst adults between 15-49 years in Uganda is estimated at 6.4 per cent. The main route of HIV transmission in Uganda is through heterosexual contacts at 80 per cent.

The risk factors for HIV transmission are multiple partners, discordance and non-disclosure, lack of condom use, transactional sex, cross-generational sex, intact foreskin and Alcohol and drug use.

Thus, in a bid to reduce the prevalence and spread of HIV/Aids, free safe male circumcision was implemented by the Ministry of Health alongside other preventive measures like Abstinence, Be faithful and Condom use (ABC) in all referral hospitals until December. In addition, Makerere University Walter Reed Project offered free mobile medical circumcision in the country complete with a surgical section and two beds. This clinic offered its first services at the fishing village of Kawongo on the remote shores of Lake Kyoga in May. On August 8 it will be in Kayunga.

Mr Mark Breda, the programme manager of the President’s Emergency Plan for Aids Relief (PEPFAR) at the Makerere University Walter Reed Project, says their 2011 target was to circumcise 6,000 men. However, “we have superseded our target because we have circumcised 7,000 men so far.”

From culture to health

Initially, male circumcision was practiced by a number of communities in Uganda. In addition to religious reasons among muslims, circumcision signifies a rite to passage from childhood to adulthood among the Bagisu.

However, from 2004, people’s perception about circumcision started changing. Data from 2004 to 2005 Uganda HIV/Aids sero-behavioural survey shows that in some societies, 24.9 per cent of Ugandan men aged 15-59 years were circumcised as a result of the change in people’s perception of circumcision. Dr Asaph Ssenoga a general practitioner at Kibuli Muslem Hospital, says in a week, they circumcise a minimum of 10 men but out of these, six or seven are non-Muslim.

“Nowadays we receive more non-Muslims than before seeking circumcision. I am sure that people are now aware that this act is not only a religious or cultural act but also a positive healthy step in one’s life,” Dr Ssenoga explains.
Male circumcision as part of HIV prevention was first advocated by the World Health Organization (WHO) and The Joint United Nations Programme on HIV/ Aids (UNAIDS) in 2007. These organisations advised all countries to include male circumcision to the available package of HIV prevention interventions.

The first trials of safe male circumcision in Uganda were conducted in 2007. The Safe Male Circumcision policy of 2010 reveals that a randomised trial conducted in Rakai in 2007, involving near 5,000 men revealed that new infections among the circumcised men were 50 per cent less compared to the uncircumcised.

Thirteen other countries in southern and eastern Africa also adopted the policy. In East Africa, Tanzania where the policy was adopted in 2009 with a target of 1.3 million MCs by 2012, has so far attained 768,000 MCs. Kenya, which adopted the policy in 2008 with a target of 860,000 men by 2011, has so far attained 76,077 cases of male circumcision. Rwanda adopted the MCs policy in 2009 with at target of 900,000 circumcised men by 2011 and so far they have circumcised 415,000 men.

According to Dr Richard Nduhura, the state minister for health, general duties, male circumcision (MC) reduces HIV infection by 60 per cent. “Based on research findings, MC reduces the risk of HIV acquisition by circumcised men by 60 per cent, WHO, Ministry of Health and scientists worldwide have endorsed MC as an effective HIV prevention strategy. As a result, there is an increased effort to develop and expand safe and cost-effective circumcision services,” Dr Nduhura said.

These results encouraged the MoH to put more efforts to ensure that most men are circumcised. However, the Uganda Aids Commission reports that 2.6 million Ugandans have been cumulatively infected with the virus, more than one million dead and two million children orphaned. It adds that statistics have been stable between six per cent and seven per cent for the last five years with the peak of HIV infection shifting from the youth to adult populations