DOES CIRCUMCISION HELP?

MBABANE – Last week, the Times SUNDAY revealed how the national circumcision drive was marred by certain anomalies.
One of these was that young boys below the age of 12 were being tested for HIV before they were circumcised.

The irregularity was that these children were then informed of their HIV status, much against the spirit of the Children Welfare and Protection Act, 2012.
Even though millions of Emalangeni are channelled yearly towards male circumcision, this has not yet helped decrease the rate of HIV infections in Swaziland.
Two national surveys have revealed that circumcision has not played a very significant role as far as decreasing new HIV infections among men.

The Swaziland Demographic and Health Survey (SDHS) survey of 2007 revealed that the relationship between HIV prevalence and circumcision status was not taking the expected direction.
The report stated that circumcised men had a slightly higher HIV infection rate than men who were not circumcised (22 per cent compared with 20 per cent).
“It is worth noting that the relationship between male circumcision and HIV infection may be compounded by the fact that the circumcision may not involve the full removal of the foreskin, which provides partial protection,” reads the report in part.

The SDHS survey was conducted by the Central Statistical Office (CSO).
Its aim was to provide the Ministry of Health and Social Welfare (MOHSW), other Government of Swaziland institutions and agencies working in the health and social services arena, with the information needed to plan and monitor programmes on HIV.

However, the Swaziland HIV Incidence Measurement Survey (SHIMS) tells a more positive story, as far as circumcision is concerned.
The study found that a majority of Swazi men remained uncircumcised.
The SHIMS is a multi-phased study that measures HIV prevalence and incidence before and after the scale-up of circumcision.  The SHIMS was initiated in 2010, to assess the population-level impact of Soka Uncobe (a male circumcision project) in the context of other HIV prevention initiatives.

The survey identified a national HIV prevalence of 31 per cent among adults aged between 18 and 49.
“It appears that the overall HIV prevalence in Swaziland has remained nearly the same over the past five years. The expansion of HIV prevention, care and treatment services since 2006 is likely a significant factor for this possible stabilisation,” reads the SHIMS report in part.

It was reported that prevalence of male circumcision among those aged between 18 and 49 in Swaziland had doubled from eight per cent (CSO 2007) to 16 per cent.
One positive of the study was that, while the vast majority of Swazi men remained uncircumcised, most were aware of the benefits.

Also, in contrast, the smaller rise in HIV prevalence among men 35 and older may indicate that HIV-infected men in Swaziland are not benefitting from use of HIV Testing and Counselling (HTC) or ARV treatment services.
The SHIMS also reported that circumcised men in Swaziland did not engage in risky sexual behaviour and were more likely to have been tested for HIV, compared to uncircumcised men. 

“HIV prevalence was significantly lower in circumcised men, reinforcing the evidence for a protective effect of male circumcision provided as a population-level (non-research) intervention,” reads the SHIMS.
This information comes as donor agencies are channelling millions of Emalangeni in efforts to get men and young boys circumcised. 

In May 2014, it was reported that the United States Agency for International Development (UNAIDS) sponsored a programme in 2011 to circumcise 150 000 males but it failed, as only 11 000 were circumcised. The Population Services International (PSI) Swaizland is also presently engaged in a programme to circumcise 2 500 boys before the opening of schools.
This programme has been criticised by organisations championing children’s rights because it involves testing the children and telling them their HIV status.

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