Should circumcision be made compulsory?

AIDS: Kenya targets more male cuts

BY CATHERINE KARONG'O

Update 1 hours and 44 minutes ago

NAIROBI, Kenya, Feb 24 - The government intends to scale up male circumcision by targeting 150,000 uncircumcised males annually in a move to reduce new HIV infections.

Head of the National AIDS and STI Control Programme (NASCOP), Nicholas Muraguri said on Tuesday that over Sh300 million would be required every year to implement the programme in the next five years.

Dr Muraguri said the Ministry of Public Health wanted to create demand in communities that do not practice circumcision, starting with Nyanza, and then move to other areas like Turkana and Teso districts.

“As for every 1,000 males who are circumcised, in high HIV prevalence areas, we avert 250 new infections of HIV. It makes economic sense then to offer this type of service to everybody,” he said.

“We are looking for a solution for HIV. We cannot continue business as usual where we have HIV prevalence at 15 percent in some regions, in some communities 30 percent and in some areas, half of the men are HIV positive,” the NASCOP head added.

“We need to work together as a team, HIV is not a regional problem it’s a national issue.”

Speaking at a briefing on male circumcision, Dr Muraguri however noted that 84 percent of adult males in Kenya were already circumcised, leaving 16 percent which the ministry was targeting.

“What we want is to circumcise as many men as possible within the shortest time.”

He said about 100,000 new HIV infections occurred in Kenya annually, which could be reduced by up to 50 percent, through the promotion of male circumcision.

Senior Programme Manager, Male Circumcision Consortium, Mores Loolpapit said the scale up followed a survey conducted two years ago in Kenya, Uganda and South Africa, which indicated that male circumcision reduced the risk of HIV infection by 60 percent.

“The results we have had from the vaccine trials in the last 10-15 years have been disappointing. Whereas we are hopeful that a vaccine would also come through, the reality is that we already have mechanisms of preventing people from getting HIV/AIDS, and what we probably need to do is to strengthen those programmes,” said Dr Loolpapit.

“We hope that by promoting male circumcision, that would be one way of preventing HIV transmission.”

Dr Loolpapit also said that at the beginning of 2000, there was a bit of evidence on circumcision and prevention of HIV but it was felt that clinical trials had to be conducted first.

“And the reasons for this were that the studies were observational and some people felt the studies did not exclude external interferences such as differences in sexual behaviour, due to differences in cultural practices.”

He said this necessitated the randomised controlled clinical trials to be done, to erase the doubts.

Biological research suggests that male circumcision is effective at preventing male acquisition of HIV because the prepuce (foreskin) contains many Langerhans cells. These are immune cells that are targeted by HIV.

By removing these cells it becomes more difficult for HIV to find an entry point into the body.

It is however not known whether male circumcision also reduces the likelihood of HIV transmission from men to women.