Over the last decade, male circumcision (MC) has been a major intervention for the prevention of HIV in sub-Saharan Africa.

Kenya, South Africa, Rwanda and Uganda, amongst other countries, have taken deliberate measures that ensure mass male circumcision. MC is known to reduce HIV infection risk by 60% and HIV prevalence has been noted to be 5% or less in regions with over 80% MC prevalence. I

t is, therefore, advisable that countries with high HIV prevalence, low MC prevalence, and generalised HIV epidemics should include MC as part of a comprehensive HIV prevention strategy. While MC drives positive health outcomes and contributes to reducing HIV and other sexually transmitted infections, there are skill challenges underlying such interventions. It is no news that the demand for medical workers exceeds the current supply.

Sub-Saharan countries specifically face alarming shortages of human resources for health (HRH) which many times results in life-threatening shortages that contribute to the high morbidity and mortality rates in the region.

In a study by a group of Ugandan surgeons and other researchers titled: The human resource crisis in surgical health care: a survey of district hospitals in sub-Saharan Africa, it was established that many health facilities in Uganda, Mozambique and Tanzania have no surgeons.

Task shifting and task sharing are key strategies that have been utilised successfully in various settings to ensure that patients’ needs are met with minimum delays. This means that Middle Level Healthcare Practitioners (MLHP) i.e., more junior medical workers like nurses, medical or clinical officers, are trained to perform or share tasks that would normally be performed by a higher-level trained person like a surgeon.

This has resulted in shortened waiting times for consultations, surgeries and other medical needs – hence bringing much-needed health services closer to the populations. So as to match the supply and demand for MC, countries like Kenya have utilised junior health workers to increase programme productivity. The target for Uganda is to circumcise 4.2 million males in five years.

International Hospital Kampala (IHK) has partnered with the Infectious Disease Institute (IDI) to provide free circumcision at the Namuwongo facility. We currently run MC camps on Saturdays that started in April 2011, and are set to continue till the programme goals are achieved. By task sharing with qualified doctors and nurses, the surgeons have steadily increased volumes by more than 250% since the camps started.

The outcomes so far have been very successful and more than 1,000 male adults have benefited from this free programme over an eight-week period. One of the beneficiaries, Samuel Kasule, 29, feels that the camp could not have happened at a better time.

“I wanted it [circumcision] a long time back but I was told I would take long to heal. Now that I’ve done it, I am pleased that I resumed work by the third day and I am now healed after 10 days.”

Dr Moses Galukande, the Programme Director for these camps and co-author of the aforementioned research paper, explains: “There has been an overwhelming response which is very pleasing and, hopefully, people fully understand the benefits and the limitations of safe male circumcision.”

Mass MC is fundamental to the prevention of HIV in sub-Saharan Africa. It is, therefore, critical that alongside condom use and other measures, effective mechanisms for delivery of MC services are adopted. Demand creation through sensitisation is important so as to encourage health-seeking behaviour. The advantages of MC must be well understood by adult males so that they make an informed choice.

Men who choose to circumcise find it easier to keep the penis clean and maintain hygiene. There is also reduced risk of HIV or other STIs (e.g., syphilis, genital warts, and herpes), reduced risk of penile cancer and reduced risk of cervical cancer to female sexual partners.

Prior to their circumcision, beneficiaries from the circumcision camps at IHK are educated on the MC process through counselling, advised on care needed during the healing process, and counselled on safe sexual behaviour and family planning. They are screened for STIs, and treated if found necessary. MC does not in anyway relegate other safe sex measures, such as condom use.

Plans are underway to expand this exercise to 10 other sites in rural and peri-urban areas in a bid to upscale MC.

The author is Director of Human Resource and Communications at International Hospital Kampala (IHK).


0 #1 Barefoot Intactivist 2011-06-16 02:18
Do some research. In 10 of 18 countries with data available, circumcised men were MORE likely to have HIV than intact men. Source: USAID 2009 Survey

Moreover, circumcision amputates the five most sensitive parts of the penis and destroys the natural gliding and protective functions of the foreskin.


~Barefoot Intactivist
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0 #2 George 2011-06-16 06:19
Mass male circumcision is definitely a positive step ahead. However, education must be part of the package given to men so that they do not think they are now immune to HIV.
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0 #3 Betty Long Cap 2011-06-16 09:32
Circumcision is a constant reminder to men not to trust in the flesh. Thus saith the LORD; Cursed be the man that trusteth in man, and maketh flesh his arm, and whose heart departeth from the LORD. Jeremiah 17:5

We Americans wonder why MC is an issue in Uganda when 80% of American males have been circumcized and most of them shortly after birth. Compare that figure to only 30% of men worldwide have been circumcised. The Judeo-Christian world has something figured out.

For the sake of women's health alone, men should volunteer to be circumcized. The queen of his life carries his child for nine months and goes to death's door in childbirth and yet he cannot face a few days of discomfort to protect the love of his life from cervical cancer?

The good news is MC skyrocketing in Africa. Attaway!
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0 #4 wodgot 2011-06-16 10:02
God wasn't stupid to create a foreskin and he wasn't stupid either to make a clitoris, who are you to chop it off?

Fore-skin is very important in keeping the tip of the penis fresh and moist. Chopping it off will leave that part dry and dead like leather.

Circumcission does not prevent you from catching HIV, it only leaves that spot dead and exposed.

Circumcission is a common practice in countries with limited source of water; you only need to wash everyday if you are a Ugandan.
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0 #5 Liz 2011-06-17 14:05
Most people living with HIV/AIDS may feel lonely and shamed. But you are MORE than your STD, so give yourself a chance to love again.
The exclusive community STDdatings. com helps you find trusted people to talk to, share medical information, get help or advice. Never feel lonely again!
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0 #6 Hugh7 2011-06-18 06:01
It's all very well to say circumcision should be "alongside condom use and other measures", but a survey by PANOS found that a majority of rural Ugandans think circumcision gives complete protection against HIV.

This will result in many people throwing caution to the wind, and hence a great INcrease in HIV infection. At best (if the trials of circumcision are correct, and that is in doubt), being circumcised will be as effective as tossing a coin every time you have sex, with "heads" meaning you are safe this time, and "tails" just as much risk as before. Condoms are much more effective than that.
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