MOSES GAHIGI discovers the benefits but also the risks involved in circumcision

While health expert around the globe engages in relentless efforts to come up with the ultimate cure of HIV/AIDS, researchers concerned with finding preventive measures aimed at slowing down the rate of infections, are also not resting.

Dr Emanuel Kayibanda, a chief surgeon at King Fisal Hospital in Kigali, revealed that Rwanda now considers male circumcision as an HIV/AIDS preventive measure.

"Male circumcision is widely accepted to be one of the measures for controlling the spread of HIV/AIDS, following the various researches conducted,” said Kayibanda.

The doctor warned however that circumcised men ought not to become complacent. Measures such as being faithful to one partner and using condoms should not be overlooked.

A report from the World Health Organisation and UNAIDS recommends that male circumcision be added to approved interventions to reduce the risk of heterosexually acquired HIV infection in men.

The recommendation was following an international consultation held early 2008, where experts agreed to name circumcision as one a control measurers for HIV/AIDS.

Three trials, carried out in Kenya, Uganda and South Africa, were stopped early because they showed such large reductions in new HIV infections — by 48-60 per cent.

It was declared that the practice of male circumcision in Africa over the next 20 years could prevent three million deaths and nearly six million HIV infections.

However, health practioners have warned that countries should consider male circumcision as part of a wider HIV prevention package, including HIV testing and counseling services. Men should not develop a false sense of security, just because they are circumcised.

The report added that since the circumcision procedure itself carries a significant risk of HIV transmission if carried out under unsafe conditions. Countries should train healthcare workers and provide certification to ensure that procedures are safe and hygienic.

"The recommendations represent a significant step forward in HIV prevention,” said Kevin De Cock, director of HIV/AIDS at the World Health Organisation.

Different susceptibility

When Aids first began to emerge in Africa, researchers found that it was more prevalent in the east and south of the continent than in the west.

Differences in sexual behaviour were widely thought to be reason for this. But some scientists argued that as circumcision was more common in west Africa, it could be reducing the risk of HIV infection, as the foreskin could be more susceptible to the virus than other parts of penis.

Circumcision only seems to have a protective effect against HIV - other sexually transmitted diseases are just as likely to be passed on, say the researchers. They believe this may be because the foreskin contains cells that the virus specifically targets.

Not without risks

Albeit being approved by researchers as one measure of combating HIV/AIDS infections, male circumcision has underlying dangers.

Factors like ignorance, naivety and the desperation to be circumcised have driven people to undertake the procedure at the hands of untrained surgeons.

Edward Kayinamura, a circumcised driver, told me of a surgeon in Bugesera who he went to and has referred many friends of his.

"Let me tell you my friend, this thing can be done perfectly well locally. I have a very good local surgeon in Bugesera, he worked on me and my other friends well…we didn’t have any problem,” revealed Kayinamura.

Rwandan males have accepted circumcision but many have looked to traditional medicine and doctors with no formal training for the procedure.

Dr Kayibanda vehemently warned people against going to traditional surgeons for circumcision, saying that such people don’t follow the proper guidelines and hygiene standards, since they didn’t undergo any surgical or medical training.

"Not everybody is trained to undertake circumcision, it is potentially dangerous to use those local surgeons overlook many considerations which turn out to be problematic” he added.

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