Friday, May 2, 2008

South Africa: Circumcision an 'Opportunity To Take Great Strides Forward' Against HIV

Inter Press Service (Johannesburg)

30 April 2008

Results from trials in South Africa, Kenya and Uganda in 2006 showed that male circumcision reduced the transmission of HIV from women to men by up to 60 percent. On the basis of these results, the Joint United Nations Programme on HIV/AIDS and the World Health Organisation have recommended that countries encourage men to be circumcised.

But, promoting this procedure is not without risk.

There is a danger that men may assume circumcision provides complete protection from HIV, and take no further steps to protect themselves. During the six to eight week healing period for the procedure, men are also more vulnerable to infection than before. In addition, many of the procedures are currently performed by traditional circumcisers under conditions that are often unsterile and which may permit HIV transmission.

To get a sense of how these constraints can be negotiated, IPS editor Kathryn Strachan talked to Mark Heywood, director of the AIDS Law Project at the University of the Witwatersrand in Johannesburg, South Africa. Heywood is also deputy chair of the South African National AIDS Council.

In light of what the trials have shown, what do we need to do now?

Large parts of Southern Africa have no tradition of male circumcision, so we need to get information out about the benefits of circumcision. Information about circumcision has already been widely publicised, but there is a lot of confusion and misunderstanding. What we need now is for the Department of Health to provide accurate, high quality information on the benefits of circumcision. This is not happening in South Africa.

How should a programme of circumcision be introduced?

Male circumcision needs to be integrated into a wider programme of male sexual and reproductive health, and it needs to be promoted as just one part of HIV prevention. Promoting it in this way it gives us an opportunity to talk about male sexual health, something that very rarely happens. A comprehensive approach also provides an avenue to HIV testing and counselling services and broader HIV prevention measures, and in doing this it encourages men to take responsibility for their health and to make informed choices.

We need to avoid having circumcision introduced in a way where men simply go into a health facility, undergo the procedure and leave. Carrying it out in a way that is separated from a wider HIV programme means that men could go back into the community without the correct understanding of circumcision as a preventive measure.

What role does tradition play in promoting circumcision?

Culture and tradition are complex issues and we still have to figure out how to approach them. What we need is to have accurate information placed in the public domain and then to leave it to individual men to make the decisions themselves, based on the information they receive. And, we need a social and community driven prevention strategy to assist men who elect to have the procedure. What we want to avoid is putting pressure on one group to be circumcised because another group is.

In light of what you've said about the best way of proceeding, what is the next step that should be taken?

The next step is to get a policy through the South African National AIDS Council, which is the highest advisory body to government on AIDS. In civil society there is a lot of confusion surrounding circumcision and this needs to be sorted out, and in government there is resistance...But circumcision presents an opportunity to take great strides forward in reducing the number of new infections, and what we need now is public messaging that provides clear and unambiguous guidance that speaks to the needs of those who elect (to have) circumcision.