Uganda: Circumcision - How Does This Men's Issue Affect Women?
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New Vision (Kampala)
COLUMN
4 August 2008
Posted to the web 5 August 2008
Milly Nattimba
Kampala
Male circumcision helps reduce HIV infection but requires communication between a couple.
The verdict is out! Medical male circumcision can reduce risk of HIV infection for men by 60%. But where are the benefits for women?
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Since the results of the medical male circumcision clinical trials were released from Uganda, Kenya and South Africa, debate has been raging on how this intervention can be effective in societies that are not traditionally circumcising, but more especially on how women benefit from male circumcision.
According to UNAIDS, by the end of 2007, out of the estimated 33.2 million people living with HIV globally, 15.4 million were women. In Uganda, of about one million people living with HIV, more than half are women.
One of the strategies that have proved effective in HIV prevention is medical male circumcision which offers 60% protection from infection.
While some argue the benefits for women are there, others insist that male circumcision does not offer women any protection. But the benefits should not be underlooked since women are more affected by HIV than men.
If men, whether HIV positive or negative are circumcised, the probability that they will pass on the virus to their partners is reduced over time, provided it is used with other prevention strategies like condoms. The benefit for women is there but it is not 100% and women need to know that even if their men are circumcised, other protective measures are still important.
The International HIV/AIDS Alliance in Uganda chief of party, Milly Katana, says reduced risk of infection in men has a multiplier effect on their partners. "If I am a woman whose partner has sex outside marriage, and he is 60% protected, his chances of infecting me are reduced by 60%." Katana adds that male circumcision does not focus on an individual, but the whole population and hence automatically offers benefits to women. "A critical mass of circumcised men will have been created, reducing chances of infecting their partners."
The AIDS Vaccine Advocacy Coalition based in New York argues that when men seek circumcision services, "the intervention could be used to provide a range of other services such as couple counselling, domestic violence interventions and condom promotion. This will indirectly protect women against infections and other social ills like gender-based violence.
Dr. Freddie Sengooba of the medical male circumcision communication project points out that the new intervention is to protect men and women through the man as the entry point. "Medical male circumcision is not a men-only intervention. Women also benefit. When we are looking at behaviour change, women are our biggest allies." Sengooba, however, cautions against over-stretching the benefits, something he said could mislead the population.
Katana says there is need to promote dialogue between couples so that before the male partner goes for circumcision, the couple knows what is involved. "Women are going to play a critical role in the success of this intervention; as mothers, opinion leaders and partners to their spouses. If your partner gets circumcised and two days later you demand sex, you will have failed the intervention."
With most Ugandans living in poverty, it is possible to consider male circumcision a substitute for condoms. While condoms have to be bought many times over, circumcision is done once.
Strategies have to be put in place to ensure that male circumcision is not used to further abuse women's sexual and reproductive health rights and compromise their sexual health and capacity to negotiate condom use.
Women and men need to be given the right information on how medical male circumcision works to reduce the HIV infection risk. Women will also need to be equipped with lobbying skills to convince their men to go for circumcision and continue dialogue on safer sex even after circumcision.
Government and civil society need to work out mechanisms that will promote the participation of women in decision-making. If implemented with proper counselling and information, and observance of six weeks of abstinence after circumcision to allow healing, the intervention can contribute to improved reproductive health status of women through their male partners.
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Posts
Circumcision of an HIV-positive man does not offer any protection to women at all. If they use condoms, it is the condoms that protect the woman, not the circumcision. (But will he be willing to wear condoms after he is circumcised?)
ReplyDeleteThe claim that "it is possible to consider male circumcision a substitute for condoms" is dangerously wrong. Condoms are much more protective than circumcision - if circumcision is protective at all. In the Ugandan study, 2,474 men were circumcised and a similar number left intact (the control gorup). After two years, 22 of the circumcised men and 45 of the control group had HIV. That is the basis of the claim that circumcision protects. But 140 of the circumcised men left the study and we don't know if they had HIV or not. They may know, because they were encouraged to get tested elsewhere, and if you learnt you had HIV after a painful and marking operation to prevent it, would you go back to the people who had done that to you?
This story is about Uganda and finding ways to fight HIV..
ReplyDeleteIf you try to project and have a broader view..
Look at countries whose main faith is Islam..
The numbers are showing that with mature behaviours and circumcision.
The HIV infection rate decreases.
I will not play with fire and assume that been circumcised is a licence to play.
I'll better be circumcised and protected