“A snip in time saves lives” say experts
It is a procedure that involves removing just a tiny flap of skin. But its benefits, as scientific studies have shown, are significant in reducing the possibility of a man becoming infected with HIV.
The skin in question is the delicate foreskin that surrounds the head of the male penis. And the procedure undertaken to remove it is male circumcision (MC) – a practice that has been carried out by various cultural and religious groups for many centuries.
As part of efforts to sensitise media practitioners on this new tool in the artillery of HIV prevention, local partners convened a one-day male circumcision workshop to sensitise print and broadcast journalists on the significance of MC within the context of HIV in Zimbabwe.
“This is more than a workshop,” noted Michael Chommie, the Country Director of PSI Zimbabwe. “We might all look back on this day a decade or two from now and inform our grandchildren that we witnessed the taming of the HIV epidemic in Zimbabwe.”
According to latest statistics provided by the National AIDS Council (NAC), Zimbabwe’s HIV prevalence now stands at 13.7%, down from a figure of 15.6% recorded in 2007. However, as the Minister of Health and Child Welfare, Dr. Henry Madzorera, noted, average Zimbabwean life expectancy has dropped in the past two decades by over 20 years, largely due to HIV.
“Low male circumcision prevalence together with high levels of concurrent partnerships are key factors that seem to have contributed to the fast spread of HIV in Zimbabwe,” Madzorera added.
After three major trials in South Africa, Kenya and Uganda all showed conclusive evidence that circumcising HIV-negative men had an effect on reducing their likelihood of contracting HIV, the World Health Organization (WHO) and UNAIDS recommended the procedure as an effective HIV prevention measure.
Overall, the trials were shown to reduce the risk of men acquiring HIV by about 60%.
“With the full consideration of recommendations made by WHO and UNAIDS, Zimbabwe adopted male circumcision as one of its additional interventions for HIV prevention in 2007,” said Gertrude Ncube, of the Ministry of Health and Child Welfare (MOHCW).
She added that the nation will soon launch its policy on MC which will provide a framework for the rollout of the service.
Currently, MC is available at four sites located in Harare, Bulawayo, Mutare and Mount Darwin. A fifth at the Manyame airbase hospital has also been initiated as a means of involving Zimbabwe’s defense forces. The sites began to offer MC in April and by the end of September had collectively circumcised 1 291 men. Through a scale-up of activities, 100 000 men are targeted to undergo the procedure next year.
But while the promise of the intervention was greatly emphasised, participants were reminded that MC will not work effectively in isolation from other HIV prevention tools.
“Male circumcision should never replace other known methods of HIV prevention and should always be considered as part of a package which includes delaying onset of sex, abstinence, partner reduction, correct and consistent condom use, and provision of testing and counselling and treatment of sexually transmitted infections, “ observed Onesimo Maguwu of the United Nations Population Fund (UNFPA).
He also added that circumcised men can still become infected with HIV and if HIV positive, can still infect their sexual partners.
As such, the intervention is currently being targeted at men who are HIV negative. As part of the standard procedure of the service, males are expected to have had an HIV test within the last month. If a man is HIV positive, the service can however still be offered to him.
However, current evidence seems to suggest that MC has no protective effects for the HIV-negative female partners of men who have already contracted the virus. A recent research carried out in Uganda suggested that circumcising HIV-positive men did not reduce the risk of their female partners becoming infected.
Media practitioners highlighted a variety of critical areas in reporting MC.
One such was the need to emphasise that MC is not a magic bullet and that it needs to work in conjunction with other prevention devices.
In addition, the procedure was said to have some rare adverse effects which included damage to the penis, problems with appearance and even cancer.
Another talking point raised during the session was the fact that the intervention was being targeted for men primarily in the 18-29 year age group, who were said to have the highest incidence of HIV in Zimbabwe.
“If a man between 18 to 29 years is said to be promiscuous, he will usually have a maximum of four women,” said Matthew Takaona, the Chairman of the Zimbabwe Union of Journalists. “But as a man gets older and has more money, he can have up to 15 different women, thereby increasing the spread of the virus.”
Further points of consideration included the 42-day healing time that is the standard for MC procedures. During this time, a man should not engage in any sexual intercourse, something which some participants felt was nearly impossible.
As part of recommendations for the way ahead, journalists mentioned the need for other key media stakeholders to become involved in sensitisation on MC.
“We need to bring editors on board,” noted Beatrice Tonhodzayi, Media Programme Officer for SAfAIDS. “When the journalists get back to the newsroom, they have little influence on the news agenda.”
It was also recommended that the journalists be given further information on the locations of the various MC sites in Zimbabwe so as to be able to visit these and write follow-up articles with patients and service providers.
“It would be good for the journalists to get the first hand experiences of patients,” observed Madeline Dube, Communications Manager for NAC.