Science Café : Safe Medical Male Circumcision

Facilitator

Esther Nakkazi

Location

Café topic

Medical Male circumcision as an HIV prevention tool. How much progress have we made?

·To provide journalists with updates on the latest developments in research on new or emerging biomedical HIV prevention options

·Help journalists to generate story and features ideas on the new and emerging biomedical HIV prevention options, critique their work and engage in thought-provoking debate

·To lay the groundwork for ongoing dialogue amongst journalists on scientifically related topics and findings, especially related to HIV issues

·To provide networking opportunities among journalists themselves, and between journalists, advocates, policymakers, researchers and implementers.

· “Media Science Cafés” present a platform for unique public engagement on issues that may be isolated from the general public, including journalists. Thesecafésare conducted in an informal setting over soft drinks, tea, and snacks that allows for casual interaction.

Participation

· Several journalists who attended the previous cafés were present as well as new journalists keen on understanding and covering health/HIV/Aids issues.

· The participation was very lively as journalists sought to understand the perception of men, women and young adults towards issues of medical male circumcision. The fears, misconceptions, and facts about the intervention etc

Partners

Highlights,key questions/Themes

Key issue: What is Safe Male Circumcision? How much progress has Uganda made in implementing the program? What are the current challenges to implementation of the program?

Dr. Barbara Nanteza, the National Safe Circumcision coordinator at the Ministry of health gave the main presentation, taking journalists through the voluntary circumcision program since the government launched it.

Dr Nanteza started her discussion by clarifying previous press reports indicating that men who had undergone circumcision were getting infected with tetanus, which would later turn fatal.

Dismissing the allegations as baseless, DrNanteza said records at the Ministry of Health show of the 2 million men so far circumcised under the government’s free program, only 5 deaths related to the procedure have been reported.

On the contrast she said within the same period, a total of 1128 people have died of tetanus, and the majority are women. This means that there is no correlation between men being circumcised and an increased risk for tetanus infection.

“We have a lot of background tetanus in our community—among children, women, and men,” she said.

She explained that there were still many myths surrounding circumcision, which was affecting the program.

“Our president does not like circumcision so any negative publicity is bad. Let us work together to make the program a success,” she said.

Outlining the progress so far made with the safe male circumcision campaign, DrNanteza said the numbers have been growing from 60,000 to a current 2 million within a period of three years.

She explained that of the 14 HIV endemic countries in Africa, Uganda is considered a success story in ensuring more men get circumcised because it was given a bigger target of circumcising up to 4.2 million men in a five-year period ending 2015.

Kenya, for instance, she says was given a target to circumcise only 800,000 men within the same period.

She explained that the government has put in place the infrastructure—including buildings and the human resources, while money for the actual delivery of the program comes from the US President’s Emergency Plan for Aids Relief (Pepfar).

However, because of the negative publicity that has surrounded the safe male circumcision program in the past few months, Pepfar will this coming financial year give money to carry out circumcision on only 300,000 men compared 750,000 in the past year.

“There is no money so unless we hype our circumcision campaign through the media we are on the downward trend. We also need to have the political will—to ensure the politicians also put money in the program otherwise it is currently being funded solely by donors,” she explained.

New methods of circumcision

Although the government started the program using the surgical method, it has recently introduced a non-surgical method, using a device called PrePex.

According to DrNanteza, clients have a choice to decide which method they want to use after they have gone through extensive counseling.

 “PrePex is the best method so far because it does not involve any blood. The health worker makes you wear the ring for 5-7 days. During this period, the foreskin gradually falls off on its own and the person returns to the health facility to have the ring removed,” she said.

Besides the PrePex for adult males, DrNanteza revealed that another similar, non-surgical circumcision method is being tested for children using a device called a glamco clamp.

A Gomco clamp is a metal device with a bell-shaped end. During circumcision, the baby’s foreskin is stretched over the bell and the clamp is tightened over his skin. The skin cuts away and the clamp is removed a few minutes later.

The pilot project, funded by the Bill and Melinda Gates Foundation, is being undertaken in Rakai district in central Uganda. At least 200 infants between the age of 1and 59 days have already been circumcised, with an additional 300 expected to undergo the procedure by the end of July.

Civil society perspective

Marion Natukunda from the AIDS Information Centre and Sylvia Nakasi from the Uganda Network of Aids Service Organisation said funding for the free circumcision program from government remains almost non-existent because it has not been made a priority.

“The president is anti-circumcision. So if we do not have the political will from the top, we cannot get the funds needed for the program to succeed,” explained Sylvia Nakasi, the policy and advocacy officer at UNASO.

Key questions from participating journalists

Do you have campaigns with educational institutions such as universities and schools?

• I know Implementing Partners (IPs) who do that but like I have told you, my job is to supervise these people who have the money. They go out to look for people to circumcise. So it is according to their working mode. They can choose to go to schools or other educational institutions.
• We go where we think we can best get these people.
• Initially, we wanted to circumcise men who are between the ages of 15 and 45. Then we found out that it was the younger people—15 and below who are coming for the services.
• So now we have lowered the age and can now do circumcision for boys who are 10 and above.
• Some people even want us to go lower to start from the age of five, but we are saying we are doing circumcision for HIV prevention so we need to target those who are sexually active, or about to become active.
• However, because we are looking for numbers and we are not getting them through the older men, we are now looking at the young people as well, even though our priority is still the older men.

What strategies have you come up with to ensure people do not perceive circumcision in a negative light?

• The first tetanus case linked to circumcision happened in July 2013. Three other cases came up in August and September 3 came in August and September 2014. I had to do research by going to a hospital in Busia where one of the tetanus cases came from. I looked at the tetanus patients at the hospital from 2009 to 2014.
•  There were about 25 cases, and out of those, none was circumcised. The majority had been knocked by bodaboda and sustained lower extremity injuries. And because they had not got a tetanus shot before, they became infected.
• So we have done research, written to all circumcision IPs on what they should do. I am coming up with a strategy and I will soon go to media houses to tell people how dangerous tetanus is. I hope after the campaign when we start circumcising again we shall not get these negative stories about tetanus being caused by circumcision.

Do you have sensitization messages in local languages?

• We started the sensitization program in the central region and soon we shall go to the north. I think they are translating them into the various local languages. We have billboards and the IPs who work in the different areas have materials and radio spots in the local languages. We have 12 languages so far.

What kind of feedback do you get from people who are circumcised?

It has now become a choice. For adolescents, it is stylish to be circumcised and it is the girls who are pushing them to do so.

For those 35 and above, the wives usually object to the men being circumcised for fear that they would become promiscuous. The women think that because it reduces the risk of HIV by 60 percent, men will go ahead and have multiple sexual partners.

We are now involving the women to tell them that if their spouses go for circumcision, they should not get angry.

When do you plan to begin the non-surgical circumcision program for babies and is it different from PrePex?

• PrePrex is something we are using among men who are 18 and above. Soon we may go even below. It has different sizes—A, BCDE. Recently, Ugandans need size FG and H for some parts of the country.
• When you come for PrePex, we first explain to you how it works. We have a sizing plate, which we put around the neck of the penis to establish the size of PrePex an individual needs.
• The PrePex stays in place for 5-7 days. Because the skin upwards stops having a supply of blood, it becomes dead and black.
• It takes 5 minutes to place the ring and 3 minutes to remove it.
• People’s skin dries at different rates. We set 5-7 days for it to dry and heal. However, we advise men who have undergone the cut to abstain from sex for about six weeks.

Resources/materials used

Stories linked to café

http://www.theeastafrican.co.ke/news/Uganda-tests-new-method-of-circumcision-for-infants-/-/2558/2718764/-/jbgg7c/-/index.htm

http://www.newvision.co.ug/mobile/Detail.aspx?NewsID=668472&CatID=1

About 15 radio stories produced but with no links.