While there is high demand for circumcision services, it is not known how many men are undertaking the surgical procedure as part of efforts to reduce new HIV infections in the country, which stand at an annual average of 130,000.
When three scientific studies in South Africa, Kenya and Uganda produced the same findings in 2007 that medical male circumcision reduces by 60 percent the chance of HIV infection in men, UNAIDS and the World Health Organisation asked countries to use it in combination with pre-existing measures such as ABC (Abstinence, Being faithful and Condom use). Recent research has also added treatment and pre exposure prophylaxis using antiretroviral therapy among discordant couples to the current prevention arsenal.
It however emerged recently at a meeting in Kampala of the Safe Male Circumcision (SMC) National Task Force, that most of the institutions carrying out circumcision don’t share their data with the ministry of Health. According to the commissioner for National Disease Control, Dr Alex Opio, it is not possible to quantify the number of procedures due to lack of a comprehensive national report.
“During supervision visits, I have found that while circumcision is happening in very many places the data is not being shared,” he said. “And as national chairperson, I do not have a single figure on the great work being done. We need to address this immediately and at least share some data on who is being circumcised, location, age group and adverse events after the surgery, if any.”
Globally, use of data for evidencebased programming is increasingly taking centre stage in public health interventions. And with modelling studies showing what targets Uganda needs in the next five years, monitoring of data will be of significant importance. In the case of Uganda for instance, 4.2 million adult/adolescent men need to be circumcised in five years to avert 340,000 new HIV infections by 2025.
However, with most circumcision programmes funded using foreign aid -now on a downward spiral – there are sustainability challenges. For example, given a decrease in funding during the August - November period, Bugiri hospital did not offer any circumcision services. This was similar in Kamuli. As a possible mitigation measure, several speakers agreed that there is need for integrating circumcision services in the health system to ensure sustainability.
But according to the UNAIDS Country Representative in Uganda, Musa Bungudu, the predicament should be an opportunity for African countries to rethink national funding priorities. “This very week, together with colleagues from the ministry of Health and Uganda AIDS Commission, we met parliamentarians and asked them how they could help. Their answer was that we present a costed plan. That is all they need and take it from there.”
At the recent 16th international conference for AIDS and STIs in Africa, five international organisations launched a strategic framework for action to spur and coordinate efforts to circumcise 20.3 million men in 14 countries including Uganda in eastern and southern Africa by 2015. This was prompted by modelling studies that suggest that reaching, and then maintaining, 80-percent male circumcision coverage among men ages 15 to 49 years in these countries would prevent 3.4 million new HIV infections by 2025, saving an estimated $16.5 billion in HIV treatment costs.
The World Health Organization, the Joint United National Programme on HIV/AIDS, the US President’s Emergency Plan for AIDS Relief, the Bill & Melinda Gates Foundation, and the World Bank developed the framework in consultation with national ministries of health.