Africa: Obstacles Slow an Easy Way to Prevent HIV in Men
September 30, 2011
Male circumcision can cut the risk of female-to-male HIV transmission by 60 percent or more, but mass circumcision campaigns have been slow to gain momentum in Africa. International health authorities in 2007 had hoped to circumcise more than 20 million men -- or about 80 percent of men ages 15-49 in 14 African countries -- by 2015. However, the 600,000 procedures done so far amount to just 3 percent.
The projected $2 billion cost would be offset by averting 4 million HIV infections and $16.5 billion in associated expenses. Each five to six circumcisions prevents one infection, said Dr. Robert Bailey, a University of Illinois-Chicago epidemiologist, who helped design Kenya's program. In addition, men undergoing the procedure often agree to HIV testing and counseling on reducing sexual risks.
Kenya's 330,000 male circumcisions so far represent one-third of its goal but still account for the most progress made among the target countries. Unlike many in Kenya, the Luo tribe did not practice circumcision, and it took months to persuade leaders to back the campaign. Encouragement by Prime Minister Raila Odinga, a Luo, "really opened the floodgates," Bailey said.
Kenya uses high-volume strategies not tied to a hospital, conducting mass circumcisions during vacation weeks, and deploying mobile teams. Nurses and physician assistants can also perform the procedure.
In contrast, in South Africa, Zambia, Zimbabwe, and other countries doctors alone are expected to perform circumcisions. At Orange Farm, South Africa, an assembly-line model, adapted by having nurses perform pre- and post-operative tasks, allows doctors to spend less time per patient. The country has allocated $33 million to male circumcision.
Tanzania, where many males are circumcised, targets areas with low rates of circumcision but high HIV rates. Of the government's goal of 2.4 million circumcisions, 110,000 have been performed.
Zimbabwe's program goes door-to-door and into schools, puts on plays about circumcision, and enlisted a popular reggae star, Winky D., to promote the surgery. Some groups that practice traditional circumcisions are now letting doctors perform them, reducing risks.
09.27.2011; Pam Belluck
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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