Zambia Mobilizing to Circumcise Men to Protect Them From HIV
September 4, 2012
The circumcision blitz has kicked into full swing. Overwhelming evidence has shown that removing the foreskin from the penis can reduce the risk of HIV transmission from a woman to a man by 60 percent -- and some studies have reported even higher numbers.
The impact of circumcision is greatest in Africa, where 23 million people are living with HIV/AIDS. Across the continent, 62 percent of men are already circumcised, but the rate plummets to 20 percent in the southern countries of Africa, where HIV has taken its greatest toll.
Circumcision is not a cure for HIV/AIDS or even a perfect form of prevention. Sixty percent is not the same as 100 percent. But raising the percentage of men who have undergone the procedure helps chip away at HIV transmission. Policymakers are aiming toward circumcising 80 percent of African males by 2015, and the push was evident at the International AIDS Conference this summer. Speakers, beginning with Secretary of State Hillary Clinton, praised the benefits of the procedure. International agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria are financing the effort.
The promise of circumcision is one thing, but the reality is more complicated. In Zambia, where 14.3 percent of the population is living with HIV, only 13 percent of men ages 15-49 have undergone the procedure. Low awareness, a lack of trained medical providers and straight-up fear have conspired to keep the rates low.
But policymakers are scaling up. This month the Zambian Ministry of Health rolled out a national campaign in hopes of circumcising an estimated 2 million males by 2015: "Male circumcision is the best vaccine in Africa," says Manasseh Phiri, M.D., a newspaper columnist and HIV/AIDS activist who was circumcised earlier this year. "It works."
What does the practice of circumcision really look like on the ground? In the Nangoma district of Zambia, where 18 percent of the population is infected with HIV, Fred Mbewe circumcises men on Thursday and Friday at the Nangoma Mission Hospital. Last year he performed 120 circumcisions, and he says the demand is usually greater than the supply.
"We have been educating them about the benefits, so many days we have cues of people waiting," says Mbewe, 25, a nurse. "There have been times when there are so many that we get overwhelmed."
Mbewe relies on a team of volunteers to recruit men from the surrounding community. Austin Muyambela, 35, was circumcised a year ago and now educates other men about the procedure. "I had my son circumcised, too," says Muyambela, whose child is 9 years old. "I thought, let me prepare this boy now."
When he speaks to men, Muyambela explains that circumcision can reduce the risk of HIV infection in men and possibly decrease the chance of cervical cancer for women.
"I also tell them about hygiene," says Muyambela, whose day job is hospital groundskeeper.
Despite his enthusiasm, counselors like Muyambela sometimes come up against barriers to circumcision that make individual men shy away. The first is pain, though Muyambela explains that the procedure is done under local anesthesia and his circumcision didn't hurt. Other men are unwilling to forgo sex during the six-week healing period after the procedure.
Others balk for cultural reasons. Circumcision is linked to the Luvale and Lunda tribes in the northwestern province, where it is a male rite of passage. "Men in our area can get confused thinking that if they get circumcised, they are a member of those tribes," explains Muyambela. "We have to educate them that isn't true."
Even as they continue to spread the word, both Muyambela and Mbewe are careful not to overpromise. "I always tell men that it's not just circumcision alone," says Mbewe. "You still have to wear a condom to prevent HIV."
Linda Villarosa runs the journalism program at the City College of New York. She traveled to Zambia with a delegation of journalists, sponsored by the Global Fund. For more about the trip, go to wheninzambia.com.
This article was provided by The Black AIDS Institute. It is a part of the publication Black AIDS Weekly. Visit Black AIDS Institute's website to find out more about their activities and publications.
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