Allafrica
In the wake of the latest statistics, which are startling and in stark contrast with perceptions that Uganda is doing well in the fight against HIV/AIDS, mayors have joined the campaign to contain the pandemic’s spiraling new infections.

According to figures from numerous studies conducted last year, 129,000 people (including 24,000 babies) contracted the deadly virus (HIV) that causes AIDS. Previous surveys done in 2007 and 2010 had new infections at 115,000 and 120,000 respectively. An estimated 1.2 million Ugandans live positively and the pandemic kills 64,000 people annually.

The latest figures on new infections translate to at least 350 people contracting HIV every day in the country. Based on the increasing rate of new infections, experts are worried that the numbers could triple in the next five years if prevention measures are not stepped up.

It is against this background that, on April 30, Dr Joshua Musinguzi, acting manager of the AIDS Control Programme/STD in the ministry of Health, called for renewed support from local leaders in urban areas to back ongoing prevention campaigns.

Through the Alliance of Mayors and Municipal Leaders on HIV/AIDS (AMMICAALL), mayors and other local government leaders from eight districts: Kampala, Mukono, Kabale, Rakai, Arua, Kasese, Gulu and Mayuge, reaffirmed their commitment on Monday. In what Dr Musinguzi says is a pilot project, mayors and other leaders in the aforesaid districts help the ministry of Health in mobilising communities to embrace the new ‘comprehensive’ anti-HIV/AIDS campaign.

Musinguzi said the ministry of Health is set to roll out a ‘comprehensive’ preventive campaign that will concentrate on promoting safe male circumcision (SMC) and elimination of mother-to-child transmission (EMTCT) of HIV. According to scientific research, also approved by the World Health Organisation (WHO), circumcision provides up to 60 percent protection against HIV. And, in countries like Botswana, South Africa and Kenya where EMTCT has been fully embraced, the number of HIV positive newborns declined to as low as four percent.

Negative perceptions on male circumcision, based on religion and culture, remain deeply rooted in most Ugandan communities. But Musinguzi explained that the role of mayors and other district leaders brought onboard could come in handy to promote the practice’s advantages in preventing HIV/AIDS.

Initially, Musinguzi disclosed, the circumcision campaign targets 3.8 million men (aged between 15 and 49) who are sexually active. On EMTCT, he said the ministry has decided to extend the services to health centre III facilities, which are some of the lowest community health units.

Under the new preventive strategy, officials hope they will reduce the rate of new HIV infections by 40 percent in 2015. Musa Bungudu, the UNAIDS country coordinator, noted that despite being internationally praised for being at the forefront of successful HIV/AIDS medicine trials, Uganda lags behind when it comes to implementation.

“Uganda just needs to go into action; it has a lot of information,” Bungudu said during the AMMICAALL review workshop at Hotel Africana, April 30.

Payvand
Growing acceptance of male circumcision, in Africa especially, is having a dramatic and positive effect on the fight against HIV/AIDS.

AIDS has killed 30 million people around the world since it was first reported in 1981, but according to a Johns Hopkins University affiliate, for men and adolescent boys, the one-time procedure of circumcision can mean a lifetime of reduced risk of getting HIV, the virus that can lead to AIDS.

The good news is that “in some areas, it’s becoming a social norm to be circumcised, particularly among adolescents,” said Kelly Curran, director of HIV and infectious diseases at the Hopkins affiliate Jhpiego. In sub-Saharan Africa, the region of the world most devastated by AIDS, Kenya and Tanzania are making the most progress in reducing HIV infections, she added. Jhpiego implements HIV/AIDS treatment and prevention programs funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development.

The fight to stop new HIV infections accelerated in 2007, when the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization began to scale up voluntary medical male circumcisions to reduce transmission of the virus. According to Curran, the groups that year also endorsed three surgical methods for performing the procedure following successful trials in South Africa, Uganda and Kenya. Since then, 1 million men around the world have been circumcised. Three-fourths of the procedures were funded by PEPFAR, Secretary of State Hillary Rodham Clinton said November 8 while stressing that the U.S. goal is to see a global AIDS-free generation. Clinton has noted that about 34 million people still live with the disease.

“Virtually every other strategy we have to prevent and treat HIV/AIDS depends on people doing things that are not easy,” Curran said. She cited behavioral changes such as remembering to use a condom, reducing the number of sexual partners and learning the HIV status of partners. (Jhpiego offers circumcision to men and adolescents as part of a package of services that includes teaching the correct use of condoms, testing and treating sexually transmitted diseases, promoting safe sexual practices and offering antiretroviral therapy for people who are HIV-positive.)

Circumcision is a safe and simple procedure done by well-trained and -equipped medical providers that takes 20-30 minutes, she said. There is compelling evidence that circumcision reduces the risk of sexual transmission of HIV by 60 percent, according to UNAIDS. Circumcision also has been shown to reduce urinary tract infections.

Three men wear T-shirts reading “Tohara ya Mwanaume,” or “Male Circumcision” in a Tanzanian language.

Male circumcision benefits women because it reduces the transmission of other sexually transmitted diseases such as herpes and the virus that causes cervical cancer, according to Curran.

Curran said taking HIV prevention services close to where people live has been a successful strategy. In Tanzania, for instance, Jhpiego works with a nonprofit group that uses mobile health centers so men don’t have to walk long distances to be circumcised. Jhpiego also uses radio programs and short text messages to communicate information about HIV/AIDS prevention methods to targeted groups.

In order to help other countries reach the success levels that Kenya and Tanzania are experiencing, UNAIDS and PEPFAR announced December 5 a five-year plan to expand male circumcision services for HIV prevention in 14 countries in sub-Saharan Africa. The plan was developed by the two groups along with the World Health Organization, the Bill & Melinda Gates Foundation and the World Bank, in consultation with the national ministries of health of those countries.

If 80 percent of men in the 14 countries are circumcised, 3.4 million new infections could be averted and $16.5 billion in HIV/AIDS treatment costs could be saved, Curran said. Reaching 80 percent would entail performing 20 million circumcisions on men ages 15-49 by 2015, according to UNAIDS.

The 14 targeted countries are Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.

The joint plan to scale up voluntary medical male circumcision is on the UNAIDS website. More information about PEPFAR and Jhpiego is on their websites.

UN.org

21 July 2011 – The United Nations agency at the forefront of the global AIDS response has strongly welcomed new data that provides further evidence that male circumcision is effective in preventing HIV in men.

The study, which was carried out in the township of Orange Farm in South Africa, showed a 55 per cent reduction in HIV prevalence and a 76 per cent reduction in HIV incidence in circumcised men, according to a news release issued by the Joint UN Programme on HIV/AIDS (UNAIDS).

It is the first time a study has shown that a roll-out of male circumcision procedures is effective at the community level in preventing HIV, the agency noted, as the results were announced yesterday at a conference in Rome.

“Science is proving that we are at the tipping point of the epidemic,” said UNAIDS Executive Director Michel Sidibé. “Urgent action is now needed to close the gap between science and implementation to reach the millions of people who are waiting for these discoveries.

“Scaling up voluntary medical male circumcision services rapidly to young men in high HIV prevalence settings will help reach the 2015 goal of reducing sexual transmission of HIV by 50 per cent,” he stated.

During the study, free circumcision services offered to all men over 15 years of age resulted in 20,000 circumcisions over a three-year period in Orange Farm, which has around 110,000 inhabitants.

UNAIDS pointed out that many African countries are strongly supporting the scale-up of male circumcision. Kenya has taken the lead, providing voluntary male circumcision to 290,000 men over the past three years, mostly in the province of Nyanza.

In Tanzania, where the Government announced plans to circumcise at least 2.8 million men and boys between the ages of 10 and 34 over a five-year period, a rapid results campaign in early 2011 saw more than 10,000 boys and men circumcised over six weeks.

The Government of Swaziland, which has the highest HIV prevalence rate in the world at 26 per cent of adults aged 15 to 49 years, has recently launched a plan to provide voluntary medical male circumcision to the 152,800 men in that age bracket.

While welcoming these results and other recent discoveries, UNAIDS stressed that there is still no single method that fully protects against HIV.

“To reach UNAIDS vision of zero new HIV infections, UNAIDS strongly recommends a combination of HIV prevention options. These include correct and consistent use of male and female condoms, waiting longer before having sex for the first time, having fewer partners, medical male circumcision, avoiding penetrative sex and ensuring that as many people as possible in need of antiretroviral therapy have access to it,” the agency stated.

Times Zambia

MALE circumcision  defined as the removal of the foreskin, or the extra skin that folds over and covers the head of the male private part is one of the oldest and most common medical procedures practiced globally.
The process has been practiced in Zambia and in many African countries such as DR Congo, Nigeria, among other nations.
Male circumcision is being promoted by the Ministry of Health in Zambia as part of the nation’s comprehensive HIV prevention strategy.
Baby boys below sixty days old as well as toddlers aged from seven, and men are queuing to be circumcised at both public and private health centres dotted across the country.
Male circumcision or MC is performed by first injecting the base of the male organ to numb the area that is in front of the private part.
Although the battle over who was the true discoverer of  AIDS, a pandemic that continues to ravage mankind from the time it was discovered on June 3,1981 is not known, the media and medical experts are now looking to other ways of reducing the risks of contracting HIV/AIDS.
Circumcision has been clinically proven to reduce the risk of HIV and some other Sexually Transmitted Diseases (STDs) in men, including Syphilis, Chancroid and Human Papiloma Virus (HPV).
HPV is a virus that can cause penile cancer in men and cervical cancer in women. It should be emphasised that male circumcision does not provide 100 per cent protection, hence it is important for  all circumcised men who are sexually active (after the six  week healing period is complete) to use condoms correctly and consistently every time they have sex.
To support the importance that the Government of Zambia attaches to tribes that revere the cultural practice of male circumcision, on December 2, 2002, former Minister of Health  Brian Chituwo noted that North Western Province had a peculiar lowest HIV/AIDS and Syphilis cases and partly attributed this to circumcision.
Dr Chituwo said this as former chairperson of the Cabinet committee on HIV/AIDS .
This was during the HIV/AIDS parliamentary seminar which was held at Lusaka’s Mulungushi International Conference Centre.
Dr Chituwo in recommending circumcision said the practice had proved to hold back the spread of STDs including HIV/AIDS.‘’North-Western Province has the lowest HIV/AIDS in the country because of some male practices like circumcision despite its causes of grievous bodily harm,” Dr Chituwo remarked.
“I  am ready to set up a camp and conduct the exercise.
There is no age limit for circumcision and parliamentarians should consider it as we fight HIV/AIDS in the country,” he said.
Dr Chituwo said HIV/AIDS was fuelled by poor health system, poverty, gender inequality as women could not negotiate for safer sex due to stigma and discrimination.
History seem to repeat itself to some extent.
In  the 15th  century syphilis, a venereal disease spread throughout Europe and claimed lives in many countries.
Later the disease became more of a chronic infection which remained incurable until the arrival of active Antibiotics just before the Second World War and it retained scars of stigma to people who became victims.
Then in 1981 came HIV/AIDS, a nemesis to mankind and deaths that have claimed millions of productive lives are still the irrevocable consequence that humanity is grappling with.
Sexually active people are either contracting AIDS through unprotected sex, while innocent children get the virus at delivery through their mothers.
Moreover some are infected through contact with contaminated razor blades and syringes among other ways.
For example in  2002 official statistics from the Central Statistical Office (CSO) indicated that Zambia’s population that stood at 9.3 million had an HIV/AIDS prevalence rate of 16 per cent of the adult population ranging between 15 to 49 years.
But   latest CSO statistics indicate that the population is slightly more than 13 million and the levels of new infections have drastically fallen, an indication that sexually active adults are cautious with their sexual lives.
According to Geoffrey Sikapizye, a clinician, though circumcision is not a remedy to the fight against HIV/AIDS, the removal of the foreskin in male circumcision makes it more difficult for HIV to enter the body.
“The skin on the neck of the manhood under the foreskin is very soft and moist.
During sex, this inner foreskin can get bruised or irritated.
When this happens, tiny openings appear in the foreskin that can allow the HIV virus to enter the body. Just below the foreskin there are a lot of special cells called “HIV target cells.”
There are more of these HIV target cells in the foreskin than any other part of the male body.
The HIV target cells in the foreskin act like a sponge, taking in any HIV virus that comes into contact with the private part.
Therefore after the healing process is complete in a circumcised male, the skin on the neck of the manhood becomes dry and many of these HIV target cells are removed making it more difficult for the HIV virus to enter the male body during sexual intercourse,” explained Mr Sikapizye.
Richard Zulu is one of the many people who has undergone the surgery and was full of smiles when he narrated his experience in an interview.
“I am now a real man because my organ has already been cut.
Even in the Bible it is written that Jesus Christ was circumcised immediately his parents saw it fit to take him for the practice so as to keep their tradition.
Against such biblical teachings and after observing that a Luvale friend of mine is circumcised, I became motivated as well,” Mr Zulu said.
Mr Sakapizye outlined how the process of circumcision is done.
“Before the circumcision procedure, one will be asked to participate in an education session led by a trained counselor or MC (male circumcision) provider where more detailed information about what to expect during the procedure is taught.
After the session, a client will have another one-to-one counseling session where an encouragement to take a confidential HIV test is discussed.
Knowledge of one’s HIV status before going for an MC assists in maximising the benefits of the process. Would be male clients should be informed that male circumcision is not recommended for people living with HIV.
In occasions where a client tests positive but still wants  to undergo MC ,they will need to be evaluated to see if their immune system is strong enough’’ Mr Sikapzye explained.
A clinical assessment is done before the operation to rule out any active or recent genital diseases.
If there is an active disease, it is treated before an MC is done.
Some injections of pain killing medicine is administered at the base of the private part  prior to the process to numb the entire manhood so as to enable one not to feel any pain while the foreskin is being removed.
The providers use clean needles and a special thread called suture to close up the private part  wound so it will heal quickly.
Clients are encouraged to wait for six weeks before having sex to enable the wound to heal properly.
If a client engages himself in sex, they risk damaging or delaying the healing of the sexual organ.
Besides that, one is actually at a high risk of contracting HIV and other STIs.
After all the information is gathered from experts on male circumcision and churned out for the public to know, it has to be alluded in plain language that circumcision is not a 100 per cent protection.
Circumcision is just but one of the many other interventions like abstaining and correct usage of condoms that should be employed to prevent spread of HIV.