The beauty of male circumcision…HIV positive men can be circumcised too

Shamiso Yikoniko
\nFOR 30-year-old Doubt Guzha (not his real name), voluntary medical male circumcision (VMMC) was something he did not consider important.
\nIt took a lot of convincing from his friend, only identified as Mike, for him to eventually agree to undergo VMMC.
\n“Even though I didn’t believe much in VMMC, I got more than I expected after going through the screening process,” Doubt narrated his story.
\n“As I was growing up, I had serious issues when it came to dating, mostly due to problems related to my manhood.
\n“As a result, my relationships would not last, which explains why I am still single when some men my age already have families.”
\nLike most men, Doubt was shy to talk about his reproductive dysfunctional problems with his family or friends.
\nDuring the screening for male circumcision using the Prepex device, it was discovered that he was suffering from phimosis.
\nPhimosis is defined as the inability to retract the skin (foreskin) covering the head (glans) of the penis.
\nIt may appear as a tight ring or ‘rubber band’ of foreskin around the tip of the penis, preventing full retraction.
\n“I was surprised to learn that my condition was common among men, yet I had been convinced the problem was peculiar to me alone,” he said.
\n“I was then referred to the next room for a different method of VMMC, something I dreaded but l was advised it would fix my condition so I went ahead with it.”
\nHealth and Child Care ministry’s AIDS and TB unit director, Dr Owen Mugurungi said that besides prevention against HIV, male circumcision harbours other health benefits.
\n“The numerous health benefits enjoyed by men through male circumcision include improved hygiene after removal of the foreskin, correction of some congenital conditions such as phimosis and reduced risk of passing on the virus that causes cervical cancer to their sexual partner,” said Dr Mugurungi.
\nMale circumcision is said to reduce the risk of HIV/Aids infection by at least 60 percent during sexual intercourse.
\nSymptoms of phimosis include difficulty or pain during urination and or painful erection.
\nPhimosis treatment depends on the age of the male, its severity and resulting symptoms.
\nHealth experts advise that the first choice of treatment is usually a steroid ointment that is locally applied for between four to six weeks and once full retraction is possible, the ointment is discontinued.
\nIn cases where the steroid is not successful, either circumcision or corrective surgery is performed.
\nDr Shingirai Makaure, a VMMC physician also talked about the benefits of male circumcision.
\n“There are other health benefits associated with circumcision besides protection against HIV. VMMC helps men being screened for other medical conditions such as hypospadias (a condition in which the opening of the urethra is on the underside of the penis) and a corrective surgery for a tight frenulum (an elastic band tissue under the penis which restricts movement of the foreskin), among other conditions,” said Dr Makaure.
\nHowever, despite the many benefits associated with male circumcision, most men still shy away from VMMC mainly due to the myths and misconceptions surrounding the procedure.
\nOthers shy away from VMMC due to fear of the ‘pain’ that comes with the procedure.
\n“There is a lack of adequate information on the benefits of VMMC then there are also myths and misconceptions around the subject.”
\n“There are several myths on the disposal of foreskins after circumcision. Some men shun VMMC due to the fear of pain and anxieties on whether they will still be able to perform sexually after the circumcision,” added Dr Mugurungi.
\nTo dispel the myths and misconceptions, the Ministry of Health and Child Care has trained community health workers to provide factual information to communities across the country.
\nThe ministry is developing posters and fliers that provide adequate information on VMMC. They are also working with different community leaders such as chiefs, headmen and faith-based organisations leaders to promote VMMC.
\nIn accordance with the Human Tissue Act of 2004, all foreskins obtained from circumcision are destroyed through incineration which is available at every health facility.
\nPrepex is a non-surgical, less painful and a blood-free circumcision method.
\nCircumcision using the Prepex device, which is affectionately known as the Ring, entails cutting blood supply to the foreskin end through the use of rubber bands.
\nThe device is worn for seven days and is only used by adults who are 18 years and above.
\nThe device has been proven to be safe, easy to use and easy to teach nurses and doctors.
\nIt can also be used even at the lowest level of health care where the surgical method is currently not regularly available.
\nHowever, it has been established that not all males are suitable candidates for the procedure as some have tight foreskins (phimosis), thereby making it difficult to insert the inner plastic ring.
\nNational Co-ordinator for Male Circumcision in the Ministry of Health and Child Care, Mr Sinokuthemba Xaba explained this.
\n“There are still some people, due to certain conditions, who won’t be able to be circumcised using the Prepex and hence, they can undergo the surgical procedure.
\n“We are happy that there are options for the provision of male circumcision services,” he said.
\nThis year, the Government set a circumcision target of 266 580 men. 141 000 men were circumcised between January and September.
\nThe Ministry of Health and Child Care embarked on a circumcision drive in 2009 as part of the national response to the HIV epidemic.
\nGovernment, earlier this year, launched an ambitious US$100 million Accelerated Operational Plan 2014-2018 male circumcision programme that is expected to see at least 80 percent of the male population being voluntarily circumcised.
\nCumulatively, 412 614 males have been circumcised since 2009.
\nBesides the PrePex, other official methods being used in Zimbabwe as part of the VMMC programme are the Forceps Guided Method and the Dorsal Slit Method which are both surgical methods.

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HIV positive men can be circumcised too

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Extra Reporter
\nMen living with HIV are increasingly undergoing male circumcision as it helps reduce the chances of getting re-infected.
\nThis has also been proven to decrease the risk of passing on the human-papilloma virus (HPV) that causes cervical cancer to their partners.
\nAccording to Ministry of Health and Child Care ministry statistics, a total of six percent of 209 056 men circumcised in 2014 were HIV positive.
\nThe ministry’s Director for HIV and TB unit, Dr Owen Mugurungi confirmed the development.
\n“VMMC is primarily being implemented as an HIV prevention initiative in Zimbabwe and is therefore largely offered to HIV negative men.
\n“However, as a ministry, we will not turn away any males who request to be circumcised, including those with unknown HIV status or those who are HIV positive as long as they are suitable to undergo surgery,” said Dr Mugurungi.
\n“Regarding the health benefits, the HIV positive circumcised man can still enjoy improved hygiene after removal of the foreskin, reduced risk of passing on the virus that causes cervical cancer to their sexual partner.”
\nDr Mugurungi also added that chances of being re-infected with HIV are also reduced by over 60 percent when an HIV positive man gets circumcised.
\n“However, it’s expected that all men should always have protected sex (through condom use) as this further lessens the chances of infection or re-infection,” he added.
\nAccording to the Male Circumcision Policy, ‘HIV positive men shall not be denied circumcision, but where medically indicated, male circumcision shall be provided to all men irrespective of their HIV status as and when it is medically safe to do so in the best interest of the client.’
\nThe World Health Organisation’s recommendations on VMMC state that circumcision of HIV positive individuals is generally not encouraged.
\n“As a country, we still go by the WHO recommendation and are not routinely circumcising HIV positive men.
\n“However, where an individual insists that he needs to be circumcised, further counselling and assessments are done to ensure that the individual is suitable to undergo the operation and will heal within the expected time,” added Dr Mugurungi.
\n“In this regard, precaution is necessary as individuals with weakened immunity may develop other complications which they would not have had if they were HIV negative.”

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  • Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. The investigators did not seek to determine the source of the HIV infections during their studies. They assumed all infections were heterosexually transmitted.

    Many HIV infections in Africa are transmitted by contaminated injections and surgical procedures. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Even if the claim were true, based on the studies, about 60 men had to be circumcised to prevent one HIV infection.

    Authorities that cite the studies have other agendas including political and financial. Research shows that circumcision causes physical, sexual, and psychological harm, reducing the sexual pleasure of both partners. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing
    medical instruments) are much more effective, much cheaper, and much less invasive. Even HIV/circumcision studies advise using condoms. With condoms circumcision adds no benefit to HIV prevention.

    Circumcision will not be “voluntary” when it is forced on children.

  • M Lyndon

    Male circumcision is a dangerous distraction in the fight against HIV/AIDS.

    From a USAID report:
    “There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
    (this will include men who were circumcised tribally rather than medically, but they and their partners may also believe themselves to be protected, and the whole rationale for the RCT’s into female-to-male transmission was a purported correlation between high rates of male circumcision and low rates of HIV)

    It seems highly unrealistic to expect that there will be no risk compensation. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”. This figure seems to have been unchanged in 2012.

    It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.

    Europeans don’t circumcise, South Americans don’t circumcise, Australians and New Zealanders used to circumcise but stopped, and less than half of North Americans circumcise. Why should Africans circumcise?

    Recent news from Botswana:
    “There is an upsurge of cases of people who got infected with HIV following circumcision.”

    and from Zimbabwe:
    “SOME circumcised men are contracting HIV and Aids after ditching the use of condoms, under a misguided belief that male circumcision (MC) would prevent them from getting infected”

    and from Kenya:
    “Push for male circumcision in Nyanza fails to reduce infections”

    and from Uganda:
    “A new study of 314 female s-x workers (FSWs) in Makindye division found that more than half of respondents falsely believe that once a man is circumcised, protection is not necessary during s-x.”

    and from Malawi:
    “According to the report, HIV rates have doubled in Malawi moving from 10% to 20% in 1 year. Strangely, this has been the same period that Malawians have been manipulatively forced to go through circumcision in masses with the promise that it reduces the contraction of HIV.”

  • M Lyndon

    Circumcising HIV+ men makes even less sense. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised.

    Cervical cancer?
    A 2003 paper in the Israeli Medical Association Journal discusses circumcision and cervical cancer at length and says the following:
    “Although the dispute over the association of circumcision and cervical cancer in various populations is still ongoing [23,24], there seems to be no hard evidence that circumcision prevents its occurrence in Jewish women, and it is no longer considered to play a protective role.”

    In Europe, almost no-one is circumcised unless their parents are Jewish or Muslim, but the UK, Greece, Denmark, Cyprus, the Netherlands, Italy, Luxembourg, Finland, Iceland, and Malta all have lower rates of cervical cancer than Israel. Sweden, France, Norway, Austria, Germany and Spain have lower rates than the USA.

  • 4skin4life

    Men who are HIV positve and get circumcised are 50% more likely to infect their partners. The circumsion campaign to prevent HIV is dangerous! Be a man, keep your foreskin and wear a condom. The people promoting this are making money one way or another – from front line clinic employees, to NGO leaders, to Academic institutions in the USA like Johns Hopkins “researchers”. They need to convince men to have their foreskins cut off to keep the money flowing. And don’t be fooled. The cirucmcisions they do remove way more skin than a regular circumcision which leaves at least some of the sensitivity. These people take it all!

  • EuropeanMan

    How stupid! This shows that the sole purpose of circumcising men in Africa is to circumcise them and advance somebody else’s political agenda. It has nothing to do with combating HIV.

    There are other ways of curing phimosis. And no, phimosis is not common among men. It’s relatively rare and often the result of traumatic injury during infancy.

  • Male genital cutting (“circumcision”) to treat phimosis is like beheading to treat headache. There are various non-surgical and other surgical treatments that don’t remove the most sensitive part.
    Zimbabwe is one of the 10 countries (out of 18 for which USAID has figures) where more of the CUT men have HIV than the whole men. (They did the survey twice, before and after the cutting campaign began, with the same ratio both times. HIV rates fell, but among the intact as much as the cut, so it was the education, not the cutting, that had the effect, if any.)
    Studies in Uganda have shown that cutting men INcreases the risk to women, already at much greater risk.

  • Bill Donnelly

    Why don’t Americans circumcise to prevent HIV?
    Because it doesn’t work.
    Nearly a million American men have died of AIDS. 85% of them were circumcised.
    There is nothing beautiful about the amputation of a normal body part, no matter what this article states.
    Men, keep your foreskins. Use a condom. That actually works to prevent HIV.