By Agwanda Jakorandoh
Voluntary Medical Male Circumcision Program Services (VMMCP) in Kenya has so far seen 88,217 men circumcised within Nyanza province with all clients reporting being satisfied with the services they received and complications from the surgery were low at a rate of 3.9 % with most of the complications being mild ones such as bleeding and selling.
According to a progress on VMMCP for the year 2008-09 by the National AIDS/STI Control Program (NASCOP) head Dr.Nicholas Muraguri, the number of circumcisions in Nyanza by December 2009 exceeded the program me’s goal for the first year.
“However, the high percentage of clients who were younger than fifteen particularly during the Rapid Results Initiative suggests that the program me may not yet be on track to reach 420,000 men and boys ages 15 to 49 in Nyanza by 2013” says Dr. Muraguri.
He adds that M & E data have revealed additional areas for improvement such as increasing the follow-up rates and acceptance of HIV testing and counseling.
“The Government of Kenya continues to consider evidence from M & E system and from local and international research to make decisions on how best to improve the VMMC program me and safely achieve an impact on public health within the shortest time possible” he further said.
Dr.Kim Eva Dickson a senior advisor on HIV/AIDS at World Health Organisation says that Kenya by far is in the lead in terms of how they’ve got their policy done and in the number of circumcisions they’ve done.
“What has impressed me about Kenya is the speed with which they’ve been able to move from policy to strategy and then to service delivery” Dr Dickson added.
ENDS
Since the 1990s studies on whether male circumcision can be used as a preventive measure against HIV continue to be at great variance. Caldwell and Caldwell (1994) used geographical distribution evidence to argue that the association between lack of circumcision and a high level of HIV infection in Africa is credible.
Others like De Vincenzi and Mertens (1994) opine that the evidence for a relationship based on miniature surveys, is unconvincing and hence not conclusive enough to qualify male circumcision as an effective intervention. Siegfried et al (2005) point at an association between lack of circumcision and increased risk of HIV; but they conclude that the quality of evidence is insufficient to warrant implementation of male circumcision as a public health measure. In other words, they opine that there could be other factors besides lack of circumcision that could explain the higher rate of HIV infection in the males who are traditionally not circumcised.
In 2006, a press release from the American National Institutes of Health (NIS) cited Kenya and Uganda as study cases. The studies showed that about 56 circumcisions were needed to prevent one HIV infection. It must also be understood that in this particular context an association between circumcision and HIV infection did not prove a cause and effect relationship. There were definitely confounding variables. Moreover, the studies failed to avoid selection bias and expectation bias. From the foregoing, I am yet to come across a study that conclusively points at male circumcision as a preventive measure against HIV infection.
Given the existing information gaps, it would be naïve for anyone to appear to be billing male circumcision as public health policy. Such judgments are extremely dangerous. Unfortunately, the public continues to be inundated with popular reports from both the public health practitioners as well as from some sections of the media indicating that the likelihood of one contracting HIV after undergoing circumcision is minimal. They haughtily opine that it (male circumcision) reduces HIV infection by 60%. This may be so. But is a more than forty percent chance of infection (after a risky sexual behavior) minimal by any standards?
Such miscommunication is likely to have far reaching ramifications in the fight against the AIDS scourge in this country. Already reports are emerging that men who have recently undergone circumcision (in arrears where male circumcision is not a tradition) are eagerly waiting for the forty days in the wilderness to lapse (recuperation) before they rush into sexual frenzy. This is because they have inadvertently been made to believe that male circumcision is a substitute for other known prophylactic measures. Such misinformation will obviously contribute to the high rate of HIV infection in the regions where male circumcision is being billed as a preventive measure to HIV.
In my opinion behavioral factors are far more important in preventing new infections than the presence or absence of a foreskin. It is therefore incumbent upon the public health practitioners as well as the mainstream media to come up with an effective communication tool that will completely eradicate the myths surrounding male circumcision. Those being circumcised must be told in no uncertain terms that male circumcision is just but part of a comprehensive prevention package, which includes among other things; correct and consistent use of male or female condoms, faithfulness among married couples, reduction in the number of sexual partners, delaying the onset of sexual relations and HIV testing and counseling.
TOME FRANCIS,
BUMULA.
http://twitter.com/tomefrancis
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