Male Circumcision as an AIDS “Vaccine”
“Pay me 5,000 Kenyan Shillings (US $60) and I’ll get circumcised” a man tells me in Kiswahili while at a bar in the village of Gwassi. He was dancing to the music playing in the background and appeared to be a bit drunk. Nevertheless, I was not expecting to be greeted by such a comment even by a drunk man. This tiny bar, made out of some wood, sheets of tin and consisting of a few wooden tables and some plastic chairs was my first meeting spot with Collins Muchara, a fisherman and an advocate for voluntary medical male circumcision. I was sitting next to Muchara introducing myself when the stranger approached me with that comment. Clearly, Muchara appeared to be known in the community as the “circumcision guy” and this stranger in turn had also associated me with being an advocate for male circumcision. Advocacy for male circumcision was not what had brought me to Gwassi; rather, it was a desire to talk to Collins Muchara about his work which had brought me to this beautiful, remote fishing village on the shores of Lake Victoria.
Male circumcision is the surgical removal of the foreskin of the penis and is a ritual certain groups perform on boys and young men based upon their cultural and religious beliefs. Some believe that it is part of a boy’s entrance into manhood. However, clinical trials conducted in Sub-Saharan Africa, including in Kisumu, Kenya, have shown that medically performed male circumcision (carried out by trained medical professionals) reduces the transmission of heterosexually acquired HIV by around 60%. Based on these findings in 2007, the World Health Organization and the Joint United Nations Program on HIV/AIDS (UNAIDS) issued recommendations to countries to offer male circumcision as an intervention to prevent HIV transmission. In 2008, these recommendations in turn prompted Kenya’s Ministry of Health to prioritize voluntary medical male circumcision services and establish a goal of circumcising 860,000 men by 2013. Their target was to reach men in areas which had a low prevalence of circumcised males and a high prevalence of HIV. Data from the 2007 Kenya Aids Indicator Survey (KAIS) showed that nationally 85% of Kenyan men were circumcised, but the Nyanza region had the lowest rates of male circumcision (48.3%) and highest prevalence of HIV (14.9%). Approximately half of uncircumcised Kenyan boys and men reside in the former Nyanza Province, which is dominated by the Luo ethnic community which does not practice circumcision as a cultural tradition. Convincing men to be circumcised in this region is not an easy task given their beliefs and the many myths that surround this procedure.
Collins Muchara was once a typical fisherman who was opposed to the concept of circumcision for fear of being unable to go back to work in the lake. Up until around 2010, like his friends, he too believed in the myths surrounding male circumcision. One myth that men will never be able to have a child if they are “cut.” However, Muchara’s perception changed when he met Erick Okioma in a nearby village via an outreach group working with the NGO, World Vision. Okioma, a person living with HIV and currently Kenya’s National Candle Light Coordinator, is a strong advocate for getting people the right information about HIV transmission and also ensuring that those living with the virus are able to get the services they desperately need. He managed to convince Muchara of the benefits of being circumcised. Now Muchara himself has become a strong advocate within his own community and tries to spread the message among his fellow fishermen. He proudly tells us that he had managed to get around 10 other men and young boys to be circumcised.
When asked about the challenges they face, Okioma says, “we have many parents who will take their children to get circumcised, but it is harder to get the men to go because they do not have the right information.” Getting that information to these remote communities along the lake is indeed a challenge because of the terrain. It was an obstacle even our team faced while making the trek out to Gwassi. As Okioma notes, “most often people who are able to provide these services lie in cities and towns, but out in the rural villages there is hardly anyone.”
According to the 2012 Kenya Aids Indicator Survey KAIS, the proportion of Kenyan men who were circumcised had reached 91%, an increase of 6% from 2007. Nyanza region had also observed the highest increase in male circumcision rates, from 48% in 2007 to 66% in 2012. No doubt this data indicates a stride in the right direction in complying with the WHO recommendations. The survey also found that the HIV prevalence in uncircumcised Kenyan men was five times higher than in those circumcised. Addressing some of the challenges both Muchara and Okioma highlighted will help Kenya to achieve its objectives of successfully counseling men to be circumcised.