GULU, 22 December 2010 (PlusNews) – After years of hearing about the protective effects of medical male circumcision against HIV, many men in northern Uganda are taking advantage of a government move to provide the procedure free of charge.
Uganda launched its national male circumcision policy in September 2010; in 2006 a large study in Kenya, South Africa and Uganda found that the procedure can reduce a man’s risk of contracting HIV through vaginal intercourse by as much as 60 percent.
Nationally, about 25 percent of Ugandan men are circumcised, but in the north, that figure drops to as low as 2.4 percent in the north-central Acholi and Lango sub-regions.
So far, men in the north are turning up for the procedure in large numbers – in Apac District, Lango sub-region, where the programme began in September, more than 1,300 men have already been circumcised. In the Acholi sub-region town of Gulu, more than 100 men registered for the procedure in the first week, while Lira, also in the Lango sub-region, saw more than 250 men circumcised in the first week.
“I learnt of the circumcision from my wife who heard it over a radio announcement; she advised me to get circumcised as a precautionary measure,” Richard Odong said at a hospital in the northern town of Gulu.
The service has been available in major hospitals, but has been too expensive for men in the region; the availability of the service for free has encouraged many more men to undergo circumcision.
“The cost of circumcision is quite expensive, unaffordable for the rural communities,” said Paul Sserubiri of the Catholic Medical Mission Board, an NGO involved in the male circumcision programme in the north. “In Gulu it costs 30,000 shillings [about US$14] – with the high level of poverty here they can’t afford it.”
Health officials in the north say the introduction of free male circumcision is a much-needed addition to the region’s HIV prevention tools. “The trend of HIV infection in northern Uganda with a higher prevalence rate than the entire country is worrying; t he number of people getting infected with HIV/AIDS is going up,” said Andrew Ocero, director of clinical services for the Northern Uganda AIDS Malaria Tuberculosis Control Programme.
“It [male circumcision] will complement other existing strategies like ABC [abstinence, be faithful and condom use] and PMTCT [prevention of mother-to-child transmission].”
According to the 2005 Demographic Health Survey, HIV prevalence in northern Uganda is 8.2 percent, higher than the national figure of 6.2 percent; urban areas in the north have even higher levels of HIV – Gulu’s prevalence, for example, is 11.9 percent.
The male circumcision programme is limited to five main hospitals in the districts of Apac, Gulu and Lira, but the government intends to roll it out to smaller health facilities around the region.
However, local health officials say the region’s health centres will need to be significantly improved to successfully expand the service. HIV programmes in northern Uganda have been beset by problems, including shortages of life-prolonging antiretrovirals, poor tuberculosis management and patients abandoning their ARVs due to insufficient food.
A chemist in Anaka, Nwoya District, who preferred anonymity, told IRIN/PlusNews he doubted the ability of male circumcision programmes to function properly under current levels of health service provision.
“Absenteeism from duty is common in the health centres, patients go and wait for the health staff who do not turn up, condoms and ARVs are expiring in the drug store here in Anaka,” he said. “How do you expect that they will be there to circumcise villagers if they have failed to avail the condoms for distribution?”
Charles Luwas, Gulu district HIV focal person, noted that health centres in the region faced challenges of lack of equipment and staff. Health workers have urged the government to invest in the region’s health facilities to ensure the expansion of male circumcision and other HIV services to the more remote areas of the north.