Male Circumcision Programme Facing Resistance

By Raphael Mweninguwe
Freelance Writer- Lilongwe, Malawi

Studies in RSA showed a 60% reduction in HIV infection among circumcised males aged 18-24 years.

The Malawi Government launched a year ago what it called “voluntary male circumcision programme” with an aim of circumcising 2.1 million males by 2016. The goal of the programme is to reduce HIV infections among sexually active males.

So far, the Malawian Ministry of Health announced that only 15,000 males have come forward and went through the knife. This number represents only 0.7% of the targeted population, which indicates that something must be wrong somewhere in the process as the programme now nears one year mark.

The ministry’s spokesperson, Henry Chimbali, points to a number of factors that contributed to the slow pace of the programme. He blames 'house-keeping' issues such as policy, scale up plan of the campaign, communication plan and human resources as the main contributing factors to the slow pace.

Chimbali is however, optimistic that the project will pick up towards the end of this year, yet other factors such as culture and traditional beliefs are also at play in this programme.

Circumcision, which involves the removal of fore-skin of the penis by an expert or health worker, is a religious issue as well as cultural issue. Most Christians who make up 80% of Malawi’s population don’t do circumcision, while other religions and cultures accept it as a norm.

 The Muslim community welcomes the project and some of them whom I have talked to are of the view that the project has even come late.

 “I wished we had this project long time ago. But all the same I am happy with it and I want as many people as possible to join it,” said Yusuf Mmadi, a resident in Lilongwe, Malawi’s capital.

 A member of the central region’s Islamic Association who was not ready to disclose his name in the media since he is not an authority to speak on the matter, said he was happy with it.

 “I am praying in Lilongwe at the Lilongwe Mosque and I am just a member of the Association but I can assure you that we are ready to support government on this one,” he said.

 Muslims in Malawi already undergo the male circumcision according to their religious belief and they believe that this project will even help reduce the risks of contracting the virus.

 Governmental Fighting Against Dominant Traditions

 The Government says circumcision is beneficial in a number of ways, one of which is reducing the risk of HIV infection because the "foreskin is also susceptible to acquisition of HIV given that it has higher density of langerhans cells which have receptors for HIV."

 The programme was introduced in Malawi following the World Health Organisation (WHO) endorsement of the circumcision procedure as an HIV-prevention measure in 2007. However, implementing this programme is so controversial due to some of the factors already mentioned such as cultural and traditional beliefs in Christian-majority Malawi.

 In Malawi circumcision takes place mainly in the southern part of the country because its where there is a migrant labour population where the HIV prevalence rate is high reaching 18%, which accounts for about 70% of the country's HIV infections, according to ministry of health statistics. The northern region of the country has less number of people going through circumcision due to cultural and traditional beliefs.

 Official statistics indicate that 21% of adult males are circumcised all over the nation, but this varies on regional scale due to cultural beliefs. The north is registering 5%, the central region is 12% and the southern region with 33% of males being knifed.

 Many in the north do not believe in it and when they know you are circumcised you are likely to be laughed at.

 Those who are practicing Chinamwali or Jando cultural traditions allow their children to undergo circumcision and this is mainly practiced in the southern part of the country among the Yao tribe majority of whom belong to Islamic faith.

 Some health workers have even questioned whether circumcision will really reduce HIV infection with considering the differences in cultural and traditions in the country.

 The study in South Africa which showed a 60% reduction in HIV infection among circumcised men aged 18-24 years, in addition to two others studies conducted in Kenya and Uganda are all giving hope to scientists. The Kenyan and Ugandan studies showed that there were HIV reductions of 53% and 48% respectively.

 The Catholic bishops in Malawi recommended to their followers that they can carry on with male circumcision to help fight the infections, but the Church is still opposed to condom use.

 Role of Malawian Church

Apart from HIV/AIDS concerns, a cancer expert at Queen Elizabeth Central Hospital in Blantyre says male circumcision reduces cervical cancer and has called on authorities to use medical male circumcision as a way of reducing the diseases among women.

 Father Buleya, Secretary General of Episcopal Conference of Malawi told a local radio station, Zodiak, that circumcision "can reduce the spread of diseases that are communicable through sexual intercourse. The medical personal of our church recommended that this procedure is in line with the church's teaching."

 Apart from HIV/AIDS concerns, a cancer expert at Queen Elizabeth Central Hospital in Blantyre says male circumcision reduces cervical cancer and has called on authorities to use medical male circumcision as a way of reducing the diseases among women.

Oncologist Leo Masamba told the Malawi News Agency (MANA) that although there is no local research work done in Malawi "there are theoretical linkages between HIV virus and Human Papilloma Virus (HPV) which is one of the major causes of cervical cancer among women."

"Since cervical cancer is largely associated with HIV as sexually active women and men can take the HPV if they have sex with someone else who this cancer, there is a high probability that if HIV can be reduced by male circumcision then the same applies to cervical cancer," Masamba said.

Government estimates that 12% of Malawi's 13.1 million people are carrying the HIV virus with over 300,000 individuals are on free antiretroviral treatment with a giant increase from just 5,000 in 2004.

The Ministry of Health estimates that new HIV infections are at 70,000 cases annually and hopes that Voluntary Male Circumcision Programme will help reduce that rate and it remains now to be seen how effective the programme will be.

MALAWI: Government finally moves on male circumcision. Humanitarian news and analysis a service of the UN Office for the Coordination of Humanitarian Affairs. 10 February 2012.
Related Links:
Challenges to Anti-HIV Circumcision Program
AIDS Across Africa: What Role Does Male Circumcision Play?
Male Circumcision Greatly Reduces HIV Risk: Studies
Medical Ethics of Male Circumcision
German Parliament Debates Circumcision

Raphael Mweninguwe is a freelance Journalist based in Lilongwe, Malawi. You can get in touch with him via this address:raphael.mweninguwe@hotmail.com

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