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CSU 62/2009: GATES FUNDING FOR MALE CIRCUMCISION/ MALE CIRCUMCISION IN SEVEN COUNTRIES

Monday, 19th of October 2009

            CHILD SURVIVAL UPDATE 62/2009: GATES FUNDING FOR
     MALE CIRCUMCISION/  MALE   CIRCUMCISION IN SEVEN COUNTRIES 
      
  Dear All,
  
  Work on male circumcision is no longer confined to subsaharan Africa, as
  these items show.
  
  Good reading.
  
  Bob Davis
  
  
  1) GATES FUNDING FOR MALE CIRCUMCISION
  
  New Scientist
  Bill Gates helps fund mass circumcision programme
  
  Microsoft founder Bill Gates last week injected $50 million into a
  programme to circumcise up to 650,000 men in Swaziland and Zambia.
  
  The goal of the project is to curb the transmission of HIV in two of the
  AIDS hotspots of the world, as circumcision has been shown to more than
  halve the risk of men becoming infected.
  Funded for five years through the Bill and Melinda Gates Foundation, the
  programme is the first to massively scale up provision of circumcision
  by fully trained medical practitioners.
  Traditional methods of circumcision sometimes harm and even kill boys
  and young men. The network of 250 teams of providers will be managed by
  Population Services International, a global health organisation based in
  Washington, DC.
  "It's great news, and this is exactly what's needed," says Catherine
  Hankins, chief scientific adviser at UNAIDS. "We've been working on
  development of guidance and technical support, and these development
  partners are now being funded to take it forward," says Haskins.
  Hankins said that Kenya has the most advanced programme, with 20,000 men
  newly circumcised, and plans are also well-advanced in Botswana and
  Namibia. But she stressed that circumcision can't alone protect men or
  women against HIV, and that circumcised men should still take additional
  precautions, such as wearing condoms and not engaging in risky or
  promiscuous sex.
  "Ensuring they understand how to maintain safe behaviours is key, and
  the procedure would be 100-per-cent accompanied by education to that
  end", says a PSI spokesman.
  
  2) MALE CIRCUMCISION IN SEVEN COUNTRIES
  
  Since the publication of three randomized clinical trials on the
  prevention of HIV acquisition through male circumcision, WHO, UNAIDS and
  other partners have collaborated with governments and NGOs on promotion
  of male circumcision. Much of this work is documented on
  www.malecircumcision.org Many Web reference sources are now available,
  notably www.malecircumcision.org
  
  Below, items from five African countries, India and China.
  
  1) UGANDA PLANS POLICY ON MALE CIRCUMCISION
  
  Monitor Online  April 16, 2009
  ‘Final draft of circumcision policy for December’
  Eve Mashoo
  Kampala
  
  The Ministry of Health has said that the final draft policy of the
  Medical Male Circumcision (MMC) will be finalized by December this year.
  
  The Assistant Commissioner Health Services (National Disease Control),
  Dr. Alex Opio earlier this month launched a Task force that will kick
  start the MMC policy in the fight against HIV/AIDS.
  
  Medical workers and policy makers started putting together a draft
  policy on the new HIV preventive technology and agreed that it will
  steer the country into the right direction in the fight against AIDS.
  
  "The policy will be part of the abstinence, be faithful and condom use
  (ABC) strategy for HIV prevention," Dr Opio said. “This will ensure that
  male circumcision is performed by experienced practitioners in sterile
  settings under conditions of informed consent, confidentiality, risk
  reduction, counseling and safety”, he added.
  
  Studies have named MMC as a possible prevention of HIV; some countries
  like Rwanda have plans to adopt it. Uganda too is weighing options and
  this task force is expected to create a policy that can guide and
  support MMC so that it can freely be available in public health units
  across the country.
  
  Government is encouraging Ugandans to voluntarily visit health centers
  for this procedure. The task force will also be seeking to identify
  solutions to the limited public knowledge on MMC’s favorable health,
  cultural and religious beliefs as well as lack of facilities, resources
  and equipment all of which can affect the process of the mass
  circumcision project in public health centers.
  Dr. Alex Opio has called upon the public to embrace circumcision to
  reduce on the escalating new HIV infection.
  
  A clinical trial conducted in 2005 & 2007 showed that circumcision
  reduced the risk of HIV by 60%, the foreskin cut from the penis is prone
  to small tears, which provide a course for the virus.
  According to the 2006 Uganda Demographic and Health Survey, about 24.8%
  Ugandan men aged between 15-49 are circumcised.
  
  
  2) BOTSWANA POLICY INITIATIVE ON MALE CIRCUMCISION/
  THE COST AND IMPACT OF MALE CIRCUMCISION ON HIV/AIDS IN BOTSWANA
  
  Thu May 7, 5:46 pm ET
  
  GABORONE (AFP) – Botswana, which has one of the world's highest HIV
  infection rates, has launched a scheme to circumcise nearly half a
  million men to curb the spread the disease, the health ministry said
  Thursday.
  
  The country hopes to circumcise 460,000 men over the next five years,
  after a series of studies found that circumcised men were two to three
  times less likely to contract HIV, said Janet Mwambona, a public health
  specialist in charge of the project.
  
  "For the public health benefits of the preventive effect of circumcision
  to be realised, the Ministry of Health is supposed to cover 80 percent
  of eligible males in Botswana," she said.
  
  Government is running television and radio campaigns to encourage men to
  visit clinics for safe circumcision procedures.
  
  "All primary and district hospitals are currently booking clients and
  performing the procedure," added Mwambona.
  
  About 50 healthcare providers, including 27 doctors have undergone
  training on surgical circumcision.
  
  The rapid spread of HIV and AIDS once threatened the survival of the
  approximately two million people of the land-locked southern African
  country, until the introduction of antiretroviral drugs in 2003.
  
  According to a 2005 UNAIDS report, Botswana's HIV prevalence among
  pregnant women between the ages of 15 and 24 has stayed between 35 and
  37 percent since 2001.
  
  The rate among the older pregnant women was last measured at 43 percent
  in 2003.
  
  
  1: J Int AIDS Soc. 2009 May 27;12(1):7.
  The cost and impact of male circumcision on HIV/AIDS in Botswana.
  Bollinger LA, Stover J, Musuka G, Fidzani B, Moeti T, Busang L.
  Futures Institute, Glastonbury, Connecticut, USA.
  LBollinger@FuturesInstitute.org.
  ABSTRACT: The HIV/AIDS epidemic continues to be a major issue facing
  Botswana, with overall adult HIV prevalence estimated to be 25.7 percent
  in 2007. This paper estimates the cost and impact of the draft Ministry
  of Health male circumcision strategy using the UNAIDS/WHO
  Decision-Makers' Programme Planning Tool (DMPPT). Demographic data and
  HIV prevalence estimates from the recent National AIDS Coordinating
  Agency estimations are used as input to the DMPPT to estimate the impact
  of scaling-up male circumcision on the HIV/AIDS epidemic. These data are
  supplemented by programmatic information from the draft Botswana
  National Strategy for Safe Male Circumcision, including information on
  unit cost and program goals. Alternative scenarios were developed in
  consultation with stakeholders. Results suggest that scaling-up adult
  and neonatal circumcision to reach 80% coverage by 2012 would result in
  averting almost 70,000 new HIV infections through 2025, at a total net
  cost of US$47 million across that same period. This results in an
  average cost per HIV infection averted of US$689. Changing the target
  year to 2015 and the scale-up pattern to a linear pattern results in a
  more evenly-distributed number of MCs required, and averts approximately
  60,000 new HIV infections through 2025. Other scenarios explored include
  the effect of risk compensation and the impact of increasing coverage of
  general prevention interventions. Scaling-up safe male circumcision has
  the potential to reduce the impact of HIV/AIDS in Botswana
  significantly; program design elements such as feasible patterns of
  scale-up and inclusion of counselling are important in evaluating the
  overall success of the program.
  
   Full text is at
  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19473540
  

  3) ZIMBABWE OPENS MALE CIRCUMCISION CLINICS
  
  THE ZIM DIASPORA, Thursday, 11 June 2009 20:25 Editor News
  
  
  THE Ministry of Health and Child Welfare is promoting male circumcision
  as part of measures to reduce HIV infection and will this month open
  male circumcision clinics in Bulawayo, Mutare and Mt Darwin.
  
  According to the Minister of Health and Child Welfare, Dr Henry
  Madzorera, studies have shown that circumcision reduces the spread of
  the virus by up to 60 percent.
  
  “We are advocating for male circumcision as part of measures to control
  the spread of HIV. Studies which have been done have shown that
  circumcision reduces the spread of HIV by up to 60 percent and a number
  of countries have embraced male circumcision as a strategy to control
  the spread of HIV,” he said.
  
  A male circumcision clinic is already running in Harare at Spilhaus, at
  the Zimbabwe National Family Planning Council centre, while in Bulawayo
  a clinic will be opened at the Eye Clinic situated at the Old Memorial
  Hospital at the end of this month.
  
  Clinics will also be opened at Mutare Provincial Hospital and Karanda
  Hospital in Mt Darwin by month-end.
  
  Dr Madzorera said his Ministry was currently training doctors and other
  health practitioners on how to use surgical equipment during
  circumcision.
  
  According to information released by the National AIDS Council, male
  circumcision is generally uncommon among the majority of Shona and
  Ndebele-speaking groups.
  
  It is estimated that around 10 percent of Zimbabwean men are currently
  circumcised.
  
  Some of the circumcised men underwent the procedure for religious or
  cultural reasons.
  
  Other than reducing chances of men becoming infected with HIV during
  heterosexual intercourse by 60 percent, circumcision also offers partial
  protection against sexually transmitted diseases.
  
  Information from the NAC also says circumcision reduces cancer of the
  male organ, urinary tract infections in children and cervical cancer in
  women whose partners are circumcised.
  
  Circumcised men also find it easier to maintain penile hygiene.
  
  According to NAC, the skin on the head of the male organ becomes harder
  after circumcision and is less likely to tear or bruise, making it more
  difficult for HIV to enter.
  
  An uncircumcised man’s foreskin is soft and moist and is more likely to
  tear or get small bruises and sores that allow HIV and other sexually
  transmitted infections to enter the body more easily.
  
  The NAC, however, says even after circumcision, HIV can still enter the
  male organ but it is much more difficult for the virus to survive.
  
  “Because male circumcision does not provide complete protection,
  circumcised men should continue to use other HIV prevention strategies,
  including abstinence, reduction in the number of sexual partners,
  correct and consistent use of male and female condoms and knowledge of
  status,” says NAC.
  
  Male circumcision is relatively safe, with a low rate of complications,
  most of which are immediately and easily treated.
  
  There are no major risks associated with the operation when it is
  performed by a trained person under hygienic conditions.
  
  The wound should heal within a period of six weeks.
  
  Newly circumcised men should abstain from sex for about six weeks to
  ensure that the male organ is fully healed, as they could be at
  increased risk of infection during this period.
  
  
  4) ITEMS FROM KENYA
  
    
  A: STRUGGLING TO MEET DEMAND FOR MALE CIRCUMCISION
  
    
  KENYA: Struggling to meet demand for male circumcision
  
  KISUMU, 1 July 2009 (PlusNews) - Demand for medical male circumcision
  has   been rising in Kenya's south-western Nyanza Province since it became
  available as part of a package of HIV prevention services in November
  2008.
  
  
  Although local communities do not traditionally practice male
  circumcision,   intensive sensitization programmes by governmental and non-governmental
  organizations are boosting acceptability.
  
  "We are ensuring that this public health measure is implemented in a
  culturally sensitive environment, and that men and their families have
  the   information they need to make informed choices," said Dr Jackson Kioko,
  Nyanza's director of public health.
  
  So far 20,701 men have been medically circumcised at 124 private and
  public   health facilities across Nyanza, the only province where the programme
  has   been rolled out.
  
  Nyanza has the highest HIV prevalence in Kenya - 15.3 percent, more
  than   double the national average - and a low level of male circumcision.
  
  A national task force will coordinate wider implementation of the
  procedure, and the National AIDS Control Council has set aside 16.1
  million   Kenya shillings (US$212,500) to encourage greater acceptance of it.
  
  Dominic Oyier, 30, a member of the Luo community, which does not
  traditionally circumcise men, feared he would be ridiculed by his
  friends   and relatives if he decided to get circumcised. "Later, when I received
  the   information from community sensitizers, I thought it was a good thing,
  especially when I was told that it can even benefit my wife by reducing
  her   chances of getting cervical cancer," he told IRIN/PlusNews.
  
  "I decided to go for it ... It is a scary experience but it is worth it
  and   even some of my friends consult me because they also want to try it
  out."
  
  
  
  Challenges
  
  Dr Walter Obiero, a clinical manager at the Nyanza Reproductive Health
  Society, said the biggest challenges were the shortage of trained
  health  workers, and persuading men to abstain from sex for six weeks following
  the   surgery.
  
  "There are men who will come to the clinic seeking these services, but
  the   moment you mention that they will have to abstain for six weeks, as is
  required after the circumcision, they ... change their minds," he said.
  
  "Then there is the issue of staff constraints, especially in government
  facilities. The number of staff already trained to offer circumcision
  services falls far below the  demand, and other health services also
  need   to be attended to by the same health workers."
  
  Most of the 450 government health workers able to offer male
  circumcision   services including counselling, performing the procedure safely and
  ensuring infection control, have been trained by the Male Circumcision
  Consortium, which includes Family Health International, the Nyanza
  Reproductive Health Society, the University of Illinois at Chicago and
  EngenderHealth, a reproductive health organization.
  
  
  
  Less than one percent of male circumcisions have had an adverse
  reaction.
  "Any complication that may arise could be mainly due to the client
  ignoring   the advice of health personnel on how to care for themselves
  immediately  after the procedure," said Dr Obiero.
  
  Until more government health workers can be trained, the consortium is
  providing more than 75 percent of circumcision services, and taking a
  lead   in informing people that male circumcision provides only partial
  protection   against HIV infection, and they should keep using condoms.
  
  Women have been targeted with information about how male circumcision
  can   benefit them by reducing their risk of cervical cancer and improving
  hygiene to ensure they support the programme.
  
  Models for providing circumcision services through outreach and mobile
  services are also being explored.
  
  "The outreach services involve sending providers to health facilities
  that   do not have capacity to offer male circumcision on a regular basis, due
  to   lack of space or insufficient health personnel," said Kioko.