Tuesday, September 4, 2007

Uganda: Male Circumcision - Govt Not Ready, Urges Self-Initiative

New Vision (Kampala)

2 September 2007

Hilary Bainemigisha

THE commissioner for community health in the health ministry has advised men to go for circumcision.

Speaking at the first national circumcision dialogue forum at Kabira Country Club recently, Dr. Sam Okware said: "I advise men to take an individual decision to go for medical circumcision together with the male children under their care. The Government will start issuing guidelines and advice on how you can do it safely."

The ministry wants to use male circumcision as an opportunity to increase voluntary counselling and testing, as well as HIV preventive education. "It must be a comprehensive package, recommended to all but not mandatory," Okware said.

Male circumcision works as an HIV preventive strategy, is simple, 60% effective and can reduce HIV incidence dramatically if taken as a combination package with the official Abstinence Be Faithful, use condoms (ABC) policy, Dr Alex Opio of the Ministry of Health said.

However, the assistant commissioner of health services in the National Disease Control Department, told delegates that the Government will not rush into rolling it out before achieving a consensus on the male circumcision policy, the programme and the ethical implications.

"The Government is in a consultation process because any mistake in the implementation process may undermine the expected benefits," he said.

The average male circumcision prevalence in Uganda is 25%, with wide variations from 54.7% in Bugisu to 2.4% in the north central part, yet HIV prevalence there is 8.2%. "We need to make decisions on whether we roll out male circumcision or prioritise in high incidence areas," Opio said.

Other policy considerations in the discussions are training personnel, availing facilities and infrastructure, how to build on what is already there, doing it in full adherence to medical ethics and human rights, as well as minimising potential harmful outcomes.

The Government needs to develop a policy, plan and cost resources without hurting the existing health programmes and set standards and guidelines.

Prof Serwadda took the delegates through the male circumcision research findings from studies on more than 10,000 men in Kenya, Uganda and South Africa.

The Ugandan study, which was carried out under the Rakai Health Sciences Programme on 5,000 men, revealed that the procedure reduces the risk of new HIV infections in men by around 60%. The Uganda and Kenyan studies were halted prematurely when the positive effects shown were overwhelming.

Dr Jesse Kajimba, who represented the minister of health, said the 60% protection is even better than some of the vaccines around. "The efficacy of BCG, the tuberculosis vaccine is 33%, but don't we support it?" Kajimba, who is the senior presidential advisor of HIV/Aids, asked.

"Studies show that if we can reach 60% of circumcision in Uganda, we will have stopped transmission in the community".

The World Health Organisation simulation studies show that expanding male circumcision in Africa over the next 20 years could prevent three million deaths and nearly six million HIV infections.

Uncircumcised men are thought to be more susceptible to HIV infection because the underside of the foreskin is rich in the immune cells which attach easily to HIV. The foreskin also often suffers small tears during intercourse.