Free circumcisions for men are being carried out countrywide at present, in response to the United Nations report that medical male circumcision (MMC) reduces the risk of HIV infection by 60%.

The UN has called for MMC to be made widely available to all men living in countries which have a high prevalence of HIV infection, such as South Africa.  In response, a number of South African NGOs, going under the banner of Brothers for Life, are carrying out the circumcisions at various venues throughout the country.

The first study on the effectiveness of circumcision was carried out by the Centre for HIV and AIDS Prevention Studies (CHAPS) at Orange Farm.

The study enrolled 3 274 men aged 18 to 24 and participants were split into two equal groups. One group was circumcised straight away. The other group, serving as a control, was to be circumcised 21 months later. After 17 months, 20 men from the circumcised group, and 49 in the control group had contracted HIV.

Initially, some critics thought men might gain a false sense of security from being circumcised and then engage in unsafe sex.

Professor Mary Crewe from the Centre of the Study of AIDS said MMC might have some small role to play but it is not clear that it does.

“There is too much uncertainty about the trials and the ways in which the research was done. The real issue is that men even if circumcised still have to use condoms and this is the weak point as too many men refuse to accept this.”

However, Dr Ntlotleng Mabena of CHAPS, in an interview with Health-e, said their study had indicated that there was no change in the men’s behaviour following their circumcision.

“We compared a group of uncircumcised men to circumcised men. Both of them behaved the same. The circumcised men do not assume that the circumcision protects them better or completely.”

A man who spoke to Wits Vuvuzela on condition of anonymity testified that circumcision really worked. While having intercourse with a girlfriend, the condom they were using broke and they decided to continue with the act. Afterwards they went for HIV testing and discovered she was HIV positive, while he was negative. He attributed the fact that he did not get infected to circumcision.

“I feel there is some level of protection because, before I was circumcised, my organ, especially the tip used to be very sensitive to breaking or having some small sores and could easily be infected with rash. Now all that is a thing of the past,” he added.

However, MMC has not come without controversy. There are people who feel the money channelled towards MMC should rather be spent on condoms and medication.

Ugandan president, Yoweri Museveni is on record as saying that, instead of preaching about circumcision, health workers should be focusing more on behaviour change. “[Leaders and health workers] are busy spreading confusion of circumcision, instead of concentrating on behaviour change.”

Research has shown that Uganda has had 70% decline in HIV prevalence since the 1990s, linked to a 60% reduction in casual sex.

Published in Wits Vuvuzela 21st edition