By Hilary Bainemigisha
THE Ministry of Health is planning to roll out circumcision free-of-charge countrywide as a preventive strategy against HIV/AIDS, Dr Sam Zaramba, Director General, Health Services has said.
“We are currently conducting a needs-assessment and consulting key stakeholders in the area of HIV/AIDS policy and service delivery on how best to do this,” he said.
Male circumcision is associated with 60% reduced risk of HIV infection and the evidence is compelling, Prof David Serwada, the Dean, Makerere University School of Public Health, told stakeholders, who met yesterday at Golf Course Hotel, Kampala. He is the one who led the circumcision trial in Uganda; one of the three that convinced the world that circumcision is effective.
“Male circumcision should now be recognised as an effective prevention intervention for HIV,” Dr Alex Opio, the assistant commissioner national disease control, said. “But we are not promoting circumcision alone since it is not 100% solution. It is going to be an additional strategy, part and parcel of Abstinence, Be faithful and Condom use (ABC).”
Opio said information about circumcision was now public and people were asking the Government for the way forward. “People have the right to access a method that has been proved to work.
As the Government, we are now looking at sensitisation, policy and ethical implications; assessing our preparedness and consulting stakeholders to build a consensus before preparing the policy. To be an effective intervention, male circumcision must be acceptable to people of all faiths, tribes, communities and their leaders.”
The meeting looked at the assessment tool to be used in the coming survey to see how prepared our health facilities, people and facilitation were. This survey will be done in districts like Mbale, Kumi, Kabale, Gulu and Kampala and key stakeholders will be interviewed.
The survey is expected to advise policy makers on how to streamline supply of requirements; train more circumcision personnel, including clinical officers and registered nurses, on how to allocate resources without hurting existing health programmes; decide how best to monitor the procedures and what the best suited circumcision method is.
The meeting also asked for an input from other countries like Kenya and Rwanda where the policies are already made. It advised that where money is not enough, the rollout can be prioritised to begin in areas where circumcision prevalence is low and HIV is high. In areas like Bugisu, where circumcision is done, government will study what to build on and what to discourage. It was also suggested that testing before circumcision should not be mandatory because it may discourage some people and the Government does not have resources to test everyone.
“This procedure is important,” Opio said. “What we don’t want is a situation where we promise free male circumcision and the people flood our services and find us unprepared.”
To work effectively, circumcision should be widespread, be medical, be followed by abstinence for at least six weeks and be used as a complementary strategy to ABC.