Women also benefit from male circumcision

Herald Reporter. Africa Moyo
Male circumcision has been a major topic around the world given the benefits unearthed by researchers.Three random controlled trials have consistently shown that male circumcision is 60 percent effective in reducing HIV incidence. The trials were done at Orange Farm in South Africa (semi-urban) Rakai, Uganda (rural) and Kisumu, Kenya (urban). World Health Organisation (WHO) and UNAids guidelines recommend male circumcision for HIV prevention in generalised epidemic settings where HIV prevalence is high and circumcision is low. However, while discussion has centred on the potential 60 percent protection of males against HIV, it has spectacularly failed to articulate how females can also benefit from the circumcision of their counterparts. Population Services International-Zimbabwe male circumcision manager Mr Roy Dhlamini recently said women derive numerous benefits from male circumcision.

He said the indirect benefits include a reduction in the incidence of HIV among men, and risk of sexually transmitted infections such as syphilis.
“There is lower risk of chancroid and syphilis infection, lower risk of human papilloma virus (HPV) infection and cervical cancer possibly lower risk of gonorrhoea and chlamydia and lower risk of bacterial vaginosis,” he said.

“There is increased risk of genital ulcers in uncircumcised men and increased risk of HIV through disrupted mucosal surface of the ulcer.”
Studies have shown the inner foreskin is more susceptible to HIV infection than the external foreskin, or cervical tissue.
Apart from giving males a 60 percent cushion against HIV and Aids, male circumcision helps prevent other venereal infections, including chancroid, balanitis and penile cancer.

Mr Dhlamini said research has also shown that circumcision lowers the risk of urinary tract infections among infants. Given the multiple benefits, a number of African countries are encouraging their citizens to be circumcised.

Zimbabwe launched the male circumcision policy in 2009. Initially, there was resistance and scepticism. A recent visit to Spilhaus at Harare Hospital, where circumcision is done, revealed many men have now embraced the initiative. A long queue had already formed as early as 8am. A senior nurse at the hospital, who requested anonymity, said an average of 50 people is circumcised daily.

At one point, 200 were circumcised in one day alone. Some parents accompanied their sons to the hospital for the procedure. The nurse encouraged parents to ensure their sons are circumcised at an early age.
“Neonatal circumcision has a number of advantages: it is virtually bloodless, no sutures, fast healing (7-10 days), low complication rate, no risk of sex before healing, no loss of time from school or work and, more

importantly, that by the time an adult decides to go for circumcision, he might have been infected,” said the nurse.
She added that neonatal circumcision is “technically easier to perform than adult circumcision. It is safer, can be carried out by less qualified staff and is cheaper to perform per procedure although benefits will take longer to realise”.
The impact of neonatal male circumcision on the reduction of the incidence of HIV is anticipated to be felt in about 30 years’ time. Medical experts say the foreskin increases the rate of infection because the thinly keratinised mucosal layer of the inner foreskin is susceptible to minor trauma and abrasion and can facilitate the entry of pathogens. It is said the area beneath the foreskin is warm and moist, conditions ideal for pathogen replication.
Mr Dhlamini said scaling up medical male circumcision services to 80 percent of all adult and new-born males by 2015 would help reduce the number of new adult HIV infections by more than 80 percent by the end of 2025.
Over the 2009-2025 period, the total number of new annual infections would decline from about 90 000 to about 16 500 and the cumulative number of adult HIV infections averted would reach almost 750 000, or 39 percent of all new adult infections that would have occurred in the Base scenario.
Mr Dhlamini said scaling up neonatal male circumcision only would not avert adult infections until after the neonates have grown and become sexually active.
“As a result, most infections would not begin to be averted until after 2025,” he said.
Figures show that male circumcision prevalence is about 10 percent.
Outside of hospitals, circumcision is also performed in ethnic and religious minorities such as Xhosa, VaRemba, Yao, Changaani, parts of the Tonga and Moslem communities.