Swaziland looks to cut HIV with mass circumcision drive

Feb 25, 2011 by Jinty Jackson

"Just relax, it won't be very painful," are the last words Maqhawe Tsela hears before the nurse plunges a large needle into the base of his penis.

As the anaesthetic takes effect and the doctor readies his scalpel, 33-year-old Tsela prepares to join the ranks of a new generation of circumcised men in Swaziland, where the government has launched a mass circumcision drive to combat the world's highest HIV infection rate.

Clinical trials have suggested circumcision could halve men's chances of contracting HIV. Three studies on the practice have been so successful they were stopped early because researchers considered it unethical not to circumcise the control group.

Circumcision programmes are under way in a number of African countries, including Kenya, South Africa, Tanzania and Zimbabwe, but Swaziland's $15-million (11-million-euro) drive to circumcise 160,000 men and teenage boys within a year is the first nationwide campaign.

Time is of the essence: one in four adults is HIV positive and two percent of the country's 1.2 million people die every year of the disease.

"If you are able to do this in a short period of time, that impact is felt more dramatically," said Jennifer Albertini, country director for the United States Agency for International Development, which is funding the programme.

Health officials hope the campaign will prevent 88,000 new infections.

"Once we save those people, we will be able to shift our focus to other health priorities," said Ayanda Nqeketo, who coordinates the programme on behalf of the Swazi government.

As the programme gathers momentum, teams of community workers or "recruiters" will be deployed nationwide, their message backed up by a huge advertising campaign.

The circumcisions will either be performed at clinics or in mobile surgical units housed in tents.

"It is all hands on deck," said Nqeketo. "We have 100 percent political commitment behind us, from the prime minister down."

Everyone, that is, but King Mswati III, the polygamous monarch of the tiny southern African kingdom, who has yet to give his public support to the campaign.

"We met with the king last year and he was supportive at that time," said Albertini.

Circumcision can be a tough sell in this deeply Christian society, where it is not traditionally practiced.

"Swazis feel it is not the custom of their forefathers, they have biblical concerns and they want to know what we do with their foreskins," said Mncedisi Dlamini of Population Services International, a non-profit organisation helping with the campaign.

Misconceptions about circumcision are not easily dispelled. A joke on a local TV soap opera last year led to the widespread belief that foreskins were being sold on the streets and used to make a herbal spice mixture.

A particularly dangerous misconception is that circumcision provides 100 percent protection from .

In a sprawling shantytown known as White City outside Swaziland's commercial centre, Manzini, a team of recruiters combs the streets, persuading Swazi men to volunteer for surgery.

One man boasts that he got circumcised because it is "nice to have sex without condoms" -- drawing a furious reaction from the recruiters.

"That is NOT what he was told at the clinic!" exclaims Mbogniseni Ndzimandze, the leader of the recruitment team.

"What am I going to do when God asks me, 'Where is your foreskin?'" demands another man.

It is a question the recruiters are used to answering.

"Why do you cut your hair?" says Mzwandile Shongwe. "God could ask you that too."

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tkjtkj
not rated yet Feb 25, 2011
It is repugnant to me that the lead sentence in this article, probably in the guise of 'humor', plays on fear. Any guy reading it will cringe and its clear that that was the intended effect. That such fears can contribute to men avoiding the procedure is unconscionable. Some might say it borders on manslaughter where having the procedure done is potentially life-saving for 50% of men who choose to have this simple procedure done.
Swaziland is to be commended for taking this aggressive step.
Physorg is to be condemned for its insensitivity.

J.A., MD
Anesthesiology
rinardman
not rated yet Feb 25, 2011
Apparently you are wrong Doctor J.A. I'm a guy, and I didn't cringe when I read that. So, maybe that wasn't the intended effect? Or, maybe I'm too stupid to pick up on it.

I do know I'm smart enough to know that if given a choice between circumcision, or using condoms and avoiding sex with HIV infected persons, I would take the latter any day of the week! If a man still has to use condoms after being circumcised, what's the point?

*
zielwolf
not rated yet Feb 28, 2011
I agree with rinardman. If I had a choice, I'd rather have a needle in the base of my penis, where the muscle is thick and not very sensitive, than one at the dentist in my sensitive gums any day. yet I've survived many a dentist's needle with no deleterious psychological effects.
tkjtkj
5 / 5 (1) Mar 02, 2011

I do know I'm smart enough to know that if given a choice between circumcision, or using condoms and avoiding sex with HIV infected persons, I would take the latter any day of the week! If a man still has to use condoms after being circumcised, what's the point?


The point, sir, is to LESSEN the risk.

Sorry, but you and others here completely misunderstand the purpose of the procedure. It is NOT done to allow guys not to use condoms!!! That is an outrageous misreading of the article and of the risks of HIV. Condoms STILL should be worn! The route of the infecting virus is NOT merely thru some mechanism involving the foreskin. And those other pathways are just as dangerous after a circ as before. Where, may i ask, do you find any reference to the imagined 'choice' of 'safe sex' being a matter of either using a condom or having a circumcision?? That is just fallacious and a deadly, inaccurate conclusion.
Skeptic_Heretic
not rated yet Mar 13, 2011
Apparently you are wrong Doctor J.A. I'm a guy, and I didn't cringe when I read that. So, maybe that wasn't the intended effect? Or, maybe I'm too stupid to pick up on it.

I do know I'm smart enough to know that if given a choice between circumcision, or using condoms and avoiding sex with HIV infected persons, I would take the latter any day of the week! If a man still has to use condoms after being circumcised, what's the point?

*

You absolutely still have to wear condoms. Circumcision reduces the transmissibility of some STDs since the cleaning of the penis becomes easier. The reduced fluid contact with the permeable membrane at the end of your dick and lack of barrier wall holding said fluids against it allow for a reduced, but still significant risk of transmission.

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