KIGALI - The government has at last officially supported male circumcision as a tool to fight against HIV/Aids. But the acknowledgement comes with a call for maximum caution from the health ministry.

As such, the government says it is about to start mass male circumcision as a way of reducing the spread of HIV/Aids and Sexually Transmitted Diseases.

Recently, the World Health Organisation (WHO) recommended male circumcision as a tool for reducing risks of acquiring f HIV/Aids virus. It said circumcised men have around 60 percent-risk free chances of not acquiring the virus during sexual intercourse.

The Health ministry says that Rwanda has adopted male circumcision as one of the preventive measures against the disease.

The State Minister for HIV/Aids and other Infectitious Diseases, Dr Innocent Nyaruhirira, has urged Rwandan men to start going for circumcision at recommended medical centers where there are qualified medical personnel.

"The entire exercise would lose meaning if done unethically by just anyone because the intended goal would be missed since it would give rise to other problems resulting from complications,” Nyaruhirira said.

He said that the Health ministry is currently in the process of upgrading and availing relevant equipment in hospitals and health centers to enable the operation.

A document from the ministry states that mass circumcision would kick off with the army, police and students from higher institutions of learning.

However, Dr Nyaruhirira warned that circumcision does not provide a "green light for promiscuity because it does not guarantee 100% prevention of the virus.”

"Let no one understand that once circumcised, men can go ahead and indulge in unprotected sex because circumcision only protects you from HIV/AIDS by 60 percent. There is a big risk of 40 percent,” he cautioned.

The Director of the Aids Treatment and Research Center (TRAC) Anita Asiimwe said that circumcision had been proved several researches in Africa as a strategy for reducing HIV/Aids prevalence rate.

Last year, three groundbreaking studies conducted in Uganda, Kenya and South Africa found that male circumcision reduces a man’s risk of being infected by the human immunodeficiency virus (HIV).

"Male circumcision has been proven to be one of the ways through which Aids transmission can be prevented. Males who are not circumcised are more vulnerable to the virus than those who are circumcised,” she said.

She said that the reason why a circumcised male may not contract Aids mainly lies in the absence of the foreskin. "The foreskin harbors and nurtures many organisms including the Aids virus, which eventually enter the bloodstream.

"The same organisms will not survive on a circumcised male because they are exposed and lack the favorable conditions from which to launch their entry into the body,” Asiimwe said.

For an uncircumcised man, she observed, the foreskin peels away during sexual intercourse, leaving a tender muscle that is quite susceptible to ulceration, hence the easy transmission of the Aids virus if the partner is positive.  "A circumcised male, due to exposure, is unlikely to get any ulceration during intercourse because his skin is relatively hardened,” she said, adding that male circumcision has more advantages than just the prevention of HIV/Aids and other STDs.
 
MPs back move

"Male circumcision will not only protect the man but also the woman. The organisms harbored in the foreskin of an uncircumcised male can easily be passed on to the woman during intercourse and this is the main origin of cervical cancer,” Dr Asiimwe noted.

Meanwhile Members of Parliament have pledged their support to the government’s decision of mass circumcision.

Deputy Ezekias Rwabuhihi, a former Health minister, said: "male circumcision is a practice that we have to embrace. However it must be properly and carefully conducted.”

"If the research on male circumcision is correct as WHO said, then we have to give full support to the implementation of this policy,” Senator Aloysia Inyumba observed.

The WHO has repeatedly called on policymakers to consider using male circumcision to contain the Aids pandemic.

But some countries have been slow on this recommendation, withy most of the leaders worried that the news might instead fuel irresponsible sexual behaviors. There are also widespread concerns that desperate men might rush to unsuitable people for circumcision, which might result in far-reaching negative consequences.

US support

In a related development, the US Secretary for Health and Human Services (HSS) Mike Leavitt has announced that the US President’s Emergency Plan for Aids Relief (Pepfar) would soon begin providing money for male circumcision programmes in some African countries in an effort to reduce the spread of HIV.

Rwanda would be one of the beneficiaries of the financial assistance. An email sent to The New Times indicates that Pepfar recognises the accumulation of scientific evidence and normative guidance from the WHO and Unaids that supports safe male circumcision for the purpose of HIV prevention.

‘The Emergency Plan will follow the WHO/ UNAIDS recommendations on male circumcision for HIV prevention and each host country government’s policies and cultural norms to support interested countries in introducing the new HIV prevention intervention,’ it said.

It added: ‘PEPFAR funding can be used for male circumcision only at the request of a host country government.’

It also stated that Pepfar team in Rwanda is consulting with the Government of Rwanda, donor agencies and local partners to determine the most appropriate response for Rwanda to the scientific evidence and WHO/Unaids guidance concerning male circumcision.

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