CIRCUMCISION PREVENTS HIV

In the light of Medical Male Circumcision being identified as one of the interventions in the fight against HIV/Aids, a non-profit organisation is aiming to perform 125 000 free procedures over the next 18 months.

With Medical Male Circumcision (MMC) identified as a significant component of the National Department of Health’s strategy to prevent the spread of HIV/Aids, Right to Care will be performing tens-of-thousands of free procedures over the next year and a half.

Studies have shown that MMC reduces male HIV sexual acquisition risk from females by up to 60 percent. It also reduces the risk of other sexually transmitted infections like the human papilloma virus. This virus is one of the leading causes of penile cancer in men and, when transmitted to women, contributes to a high incidence of cervical cancer.

The Soul City Institute of Health and Development Communication believes although condom use has increased substantially over the past few years, from 57 to 87 percent, these gains are insufficient to stop the spread of HIV on their own.
According to research conducted by the institute in all nine provinces in 2010, young men, particularly from the Eastern and Western Cape, held a strong view on protecting traditional circumcision and initiation schools.

When asked to share their thoughts of what circumcision is, participants said it involved removal of the foreskin, which causes pain, and induction on cultural practices and customs.
Men believed that a good age to go for circumcision ranges from birth to 18 years.

They also said that condom use reduces the risk of getting diseases. Some of the reasons mentioned in encouraging men to circumcise were stigma, peer pressure, punishment from parents, and culture. In addition, men reported that they get better sexual pleasure after circumcision.

According to the survey, men generally disliked having a foreskin and regarded it as an irritation. They described it as too much work, as if it is not part of their body. They talked openly about the difficulties and inconvenience of having a foreskin, such as “pulling it to wash, to enjoy sex and to urinate, and putting on a condom”. Some also talked about fear of losing their partners.

The research further showed most men were aware that circumcision can decrease the chances of HIV and other sexually transmitted infections. They knew that the use of condoms must continue after circumcision. All the women talked about the health benefits of men being circumcised. They believe there is “dirt” trapped under the foreskin. They are convinced that circumcised men are safer to have sex with than uncircumcised men.

In the quest to help reduce the high number of sexually transmitted infections, non-profit organisation Right to Care together with the Health Department are scaling up efforts to promote circumcision countrywide.

Right to Care Chief Executive Officer Ian Sanne said some 125 000 free MMCs for HIV negative men between the age of 14 and 49 are going to be performed countrywide within a period of 18 months.

“MMC is an important component in the basket of prevention interventions, but continued use of male and female condoms is vitally important, even when the man is circumcised.”

To achieve this, both Right to Care and the department will be assisted by experts from the US Agency for International Development (USAID) and the President’s Emergency Plan for Aids Relief (US PEPFAR), whilst working hand-in-hand with Anova Health, The Centre for HIV/Aids Prevention Studies (CHAPS), and Maternal, Adolescent and Child Health (MatCh).

This service will be rolled out within the 15 high-quality, high-volume MMC sites servicing the Free State, Gauteng, KwaZulu-Natal and Mpumalanga. Right to Care will establish a new site in KwaZulu-Natal and expand satellite sites in informal settlements and urban areas in Gauteng.

The initiative will also conduct HIV testing and counselling, screen for sexually transmitted infections, provide male and female condoms, and link HIV-positive patients to care and treatment.
These are all within the guidelines provided by the World Health Organisation.

The programme’s second component is to provide technical assistance to the Department of Health to assist districts establish and operate high-volume high-efficiency MMC services and to efficiently utilise their resources for the MMC programme. This will take place in all nine provinces.

USAID’s Southern Africa Director Jeff Borns has welcomed the programme.

“We support HIV/Aids cost-efficient prevention strategies that work, and MMC has been tested extensively and is effective.”

Right to Care and its partners will use a model called MOVE (Maximising Options for Volume and Efficiency). This innovative service-delivery model, developed in South Africa by CHAPS, applies a forceps-guided technique. The model is being adopted internationally as a standard for large-scale MMC programmes.

Communications will be key to the success of the programme. Community advisory boards will be formed and tasked with informing service providers of community perceptions, identifying service improvements, and motivating men to be circumcised. Recent surveys indicate that over 50 percent of men are willing to be circumcised.

Existing cultural platforms and traditional authorities will be leveraged to promote norms that encourage sexual health and risk reduction. Johns Hopkins Health and Education in South Africa is spearheading a national strategy to address men’s healthcare communication needs. The organisation has set up a cellphone-based information service that provides health information via SMS or hash codes.

Men who want to be circumcised can SMS “MMC” to 43740 (standard SMS rates apply). They will be sent a hash code (*120*662#) that can be used to identify the nearest MMC facility, based on the user’s location. MMC is provided at no charge.