Reflecting on Circumcision and HIV/AIDS

Culturally, it is considered a taboo to discuss matters pertaining to sex in public domain. That is understandable. As a Malawian proudly conscious of my culture, this, and for a good reason, is the idea I totally subscribe to.
Surely, norms and values are indispensable to any society. However, when I beg to differ is when the society allows these norms to override all other concerns more especially at the expense of critical issues. For example, it is unfortunate that up to now, there are still communities in Malawi where HIV/AIDS issues are still a taboo.
This problem, it seems, is historical. It was so when first cases of HIV and AIDS were being reported in Malawi in the mid 80s. Malawians never wanted to discuss the causal relationship between sex and HIV/AIDS. Reason? Culturally, it is a taboo to share notes on sex issues. Still it was so when condoms were firstly being advocated as one of the preventive measures of HIV/AIDS. And, for the same reason, it is so with the issue of male circumcision and HIV/AIDS.
For many years now, there has been a growing body of medical and pragmatic evidence that has suggested the link between male circumcision and HIV/AIDS. The convincing evidence testifies that male circumcision reduces the risk of contracting and transmitting HIV—the virus notoriously known to be the cause of AIDS.
A research published in the Journal of Plos Medicine in 2005, suggested that male circumcision reduces HIV infection risk in heterosexual men by 50-60 percent. It further estimated that male circumcision could avert six million HIV infections and three million deaths in sub-Saharan Africa over a period of twenty years.
“There is a tremendous potential for male circumcision to have an effect on the HIV epidemic particularly in sub-Saharan Africa,” Catherine Hanking, Chief Scientific adviser to the United Nations Programme on HIV/AIDS (UNAIDS) and co-author on the study said in the report.
However, it seems evidence of male circumcision as a protective measure against HIV/AIDS dates back to the late 1980s. As I gather, researchers working in Africa and Asia noticed that HIV-prevalence rates “differed dramatically among neighbouring regions and were often lowest in areas where male circumcision was practiced.”
Recently, randomized control trials in South Africa, Kenya and Uganda have confirmed and supported the link between the two. The studies say male circumcision has a promising safety and significant efficacy.
Even pleasing to note is that circumcision has health benefits beyond HIV prevention. Researchers have discovered that male circumcision provides increased protection against the herpes, syphilis and chancroid. It also appears that male circumcision has been recommended for hygienic and sexual reasons. Surely, it seems, there is more to this issue than meets the eye.
However, what is disheartening to note is that the Malawi government has chosen to bury its head in the sand and pay a deaf ear and a blind eye to this overwhelming evidence suggesting the inextricable link between male circumcision and HIV/AIDS.
At the time when the HIV scourge is ravaging the lives of many Malawians, it is very unfortunate that the government is dragging its feet in coming out with a stance on this hotly contested subject.
Sadly, according to a slew of health reports, around 14 per cent of Malawi’s 13 million people are HIV positive with 300 cases being registered every day. What this essentially means is that about 1 million Malawians are living with the virus. So why then is Malawi not adopting male circumcision as one of the preventive measures of HIV/AIDS? One cannot find an answer to this question.
Of course, it is understandable that rolling this into action might require scaling up medical facilities and medical training for effective implementation thereby straining the country’s limited resources, but let’s be more reasonable, we are talking about saving human lives here.
To put the record straight, I am not saying the nation should rush headlong in adopting male circumcision to complement the existing interventions on HIV/AIDS, but surely, the solution does not lie in remaining silent. For, being quiet would only delude those men who are currently circumcised into thinking that they are 100 per cent protected from infection thereby shoving their precious lives to fate. It would be utter foolhardy to think that circumcision is an alternative to using condoms.
Already, other sub-Saharan countries are streets ahead of us in exploring other avenues of combating HIV/AIDS. South Africa, we gather, is developing a policy on male circumcision for HIV prevention while in Kenya, 20,000 men have been circumcised in the past year in a programme called Voluntary Medical Male Circumcision (VMMC). Botswana is also not lagging behind as it is tirelessly training teams to provide the service in all its public hospitals for free.
In Malawi, it’s now that we have heard that there was an HIV and AIDS Research and Best Practices Dissemination Conference held in Lilongwe between 2-3 July this year at Crossroads Hotel, where among other issues that were discussed was about the link between male circumcision and HIV/AIDS.
However, it remains to be seen whether Malawi, like other sub-Saharan countries, will adopt a policy out of the notes obtained at this much-needed conference. Of course, as we told, some private reproductive health institutions including some public hospitals, do conduct male circumcision for medical reasons but a government policy is needed to ensure that the operations are safe, low-cost, legal and option available. The proof of the pudding, says old wisdom, is in the eating.


The author is a Media for Development student at Chancellor College.