What you need to know:
- New phase of project is based on success of pilot scheme in Nyanza Province
Poor urban settlements will soon host a team of doctors on a unique mission: to circumcise the uncircumcised men.
Tents will be pitched all over the neighbourhoods and clarion calls made for men willing to undergo the cut to turn up for the procedure that will be on offer on the spot. This is the latest phase of the voluntary male circumcision programme as a strategy against HIV and Aids.
It follows the circumcision of about 90,000 men in Nyanza Province since the programme was launched about a year ago.
From Kisumu, which served as the focal point of the exercise, the programme is set to move to informal settlements in Nairobi. In addition, the National Aids and Sexually Transmitted Infection Control Programme (Nascop) is planning to take the idea countrywide to ethnic communities that do not traditionally circumcise their men.
Will be extended
The director of Nascop, Dr Nicholas Muraguri, says that this year, the voluntary medical male circumcision programme will be extended to the Teso and Turkana communities in Western and Rift Valley provinces, respectively.
“The leaders of these communities have been approached for their support in the planned rolling out of the project and arrangements are ongoing on how to begin the exercise,” Dr Muraguri says.
After a slow start in Nyanza Province two years ago, male circumcision is fast gaining momentum as a tactic in the fight against HIV and Aids.
Its adoption in the HIV and Aids prevention package and the Government’s eventual development of a policy to guide the process followed studies whose findings indicated circumcision significantly reduced chances of contracting the virus.
Reduces the risk
World Health Organisation (WHO) says there is compelling evidence from three randomised controlled trials that male circumcision, provided by well-trained health professionals in properly equipped settings, reduces the risk of heterosexually acquired HIV infection in men by approximately 60 per cent.
Thus, WHO recommends male circumcision as part of a comprehensive HIV risk reduction programme that includes education, counselling and testing, and correct and consistent use of condoms.
This was alluded to by results of the 2007 Kenya Aids Indicator Survey, which found that the prevalence of HIV and Aids among uncircumcised men was three times more than among their counterparts who have undergone the cut.
The male circumcision drive got a boost after it was backed by a cross-section of leaders from Nyanza Province, including Prime Minister Raila Odinga and the Luo Council of Elders.
In fact, the elders are expected to play a crucial role as the programme is scaled up in the province. They have been roped in to help in educating the community on the need to take part in the circumcision drive as well as other HIV programmes.
This is a major gain in the programme, considering that the Luo council of elders had been reluctant to support the project, insisting that they were “preserving their culture”. This was before Mr Odinga intervened.
Even now, despite publicly supporting the circumcision drive, there are voices of discontent amongst elders, with some expressing discomfort in supporting a practice that they consider alien to the Luo culture.
Nevertheless, the government is using the prevailing goodwill to drive the programme, hence the new approach where elders are required to make a more active role.
According to the director of public health and sanitation in Nyanza Province, Dr Jackson Kioko, the move was motivated by the fact that elders are custodians of culture and also public health issues in the community.
Members of the Luo Council of Elders will sit in the 13 male circumcision district steering committees that coordinate the implementation of voluntary medical male circumcision.
It is intended to build on gains that have already been made in promoting male circumcision as a strategy in the fight against HIV and Aids in the country.
Dr Muraguri says that the programme has been immensely successful, with 90,000 circumcisions done in this financial year, against a projected 110,000.
In addition, he says, Kenya has scored a first in the world in terms of the number of cuts performed in a country where voluntary medical male circumcision has been adopted as a strategy against HIV and Aids.
Towards the end of last year, the government rolled out a rapid results initiative in Nyanza Province targeted at circumcising 30,000 men in 30 days. By the end of the period, the target had been surpassed by 20 per cent.
“Our figures are more than those of the southern African countries combined,” the Nascop director says.
This has seen delegations from countries such as Botswana, Swaziland, Tanzania and Mozambique visit Kenya to learn from its programme.
Nyanza’s Dr Kioko said that by 2013, the programme aims at ensuring that 80 per cent of the men in Nyanza Province undergo the cut.
The 2007 Kenya AIDS Indicator Survey estimated the proportion of uncircumcised men between the ages of 15 and 64 in Nyanza at 48.2 per cent, compared to the national average of 85 per cent.