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