Uganda: Circumcision Not a Greenlight for Unsafe Sex

January 9, 2007
Posted to the web January 9, 2007

Arthur Baguma
Kampala

SCIENTISTS say there are several biological reasons why circumcision may decrease the transmission of HIV/AIDS. A new study carried out in Uganda and Kenya has re-confirmed this. The findings have generated mixed reactions from the public and medical experts.

The argument is that the discovery should not be presented as a cure for HIV/AIDS. Uganda's success in the fight has been the clear and precise message that there is no cure for AIDS.

President Yoweri Museveni has joined the voices of those warning that messages saying circumcision reduces the risk of HIV/AIDS could derail the AIDS fight. The President's words have also been echoed by Ugandan scientists.

Dr. David Serwada, the director Makerere University Institute of Public Health and Uganda's principal investigator in the studies, warns that the study should be understood in the right context.

"When you say circumcision reduces acquisition by 50% it does not mean it eliminates HIV/AIDS. It is just one component in our arm of prevention. If you are circumcised then it is fine, but if you practice safe sex or abstain the better," Serwada said.

Should Uganda consider a policy on circumcision?

According to officials at the Uganda AIDS Commission, a policy is necessary in light of the study findings.

Director General Dr. Kihumuro Apuuli warns that coming up with the policy is a complex issue that needs working in partnership with different stake-holders and the community.

"Pertinent issues have to be examined. For instance is it viable? Who do you target in the circumstances? Do you go to every village and circumcise every man. What are the implications of implementing the policy in terms of human resource and infrastructure, for instance? The issue has to be examined extensively before a policy is put in place."

A US report said that circumcision can halve the HIV-infection rate.

Kevin de Cock, head of the World Health Organisation's HIV/AIDS department, said circumcision could cut the numbers of infected men by "many tens of thousands, many hundreds of thousands and maybe millions over coming years."

Ministry of Health officials said they were expecting to receive the report and carefully study it before taking the next move.

"Coming up with a policy on circumcision will be considered after we have extensively studied the report," Dr. Sam Okware, the Director of Health Services, said.

How many people would afford the cost of circumcision?

The Government has to put incentives in place if such a policy is to work. The Government can consider subsidising circumcision services. Out of desperation, people will resort to crude unhygienic measures and this will escalate the problem.

According to Siraje Mbulambago, the hospital administrator at Kibuli, circumcision charges range from sh25,000 to about sh1,000,000. These figures are out of reach for the ordinary person.

At Kibuli Hospital, children aged five years and below are charged sh25,000 - sh30,000. For five and a half years and above it is sh50,000. Siraje says in some specialist centres the cost is as high as sh1m.

On the contrary if not done safely, circumcision can increase chances of contracting HIV.

It should be done in a safe environment at health centres, which is why the Government has to come up with a policy to provide these services.

If services are not provided, the people should be given opportunities to go elsewhere. We have had cases where one knife is used on more than one person.

Secondly, such services are accompanied by health safety measures, Siraje said.

However, the report warns that people should not slip up on the need to continue to protect themselves by condom use and safe sex.

The public is warned that findings do not mean circumcision prevents HIV/AIDS, but only reduces the chances of contracting the virus.

At a glance

38.6 million people were living with HIV last year, of whom 24.5 were in sub-Saharan Africa.

In some African countries more than a third of the population is infected with HIV/AIDS.

4.1 million became infected with the virus during the course of the year 2006 - 2.7 million in sub-Saharan Africa. UN agencies are calling for more efforts on prevention.

2.8 million people died of AIDS-related illnesses in 2005.

Around 8.3 million people in Asia are HIV infected, two-thirds in India.