Monday, January 17, 2022

Botswana puzzled by upsurge in HIV infections among circumcised men

Obtuse messaging in the campaign to encourage male circumcision seems to be backfiring following reports of an upsurge in the number of HIV/AIDS infections among circumcised men.
Deborah Retief Memorial Hospital Superintendant Dr Motlalepula Powe, told Kgatleng full Council meeting on Thursday that a bewildering upsurge in HIV cases among circumcised men has been observed.
The latest revelation by Powe comes as Botswana officially declared it was encouraging the practice of male circumcision as a way of curtailing the rate of HIV infections prevalent in the country.
Indications are that some men may have believed that circumcision was a substitute for condoms.
Superintendent Powe said it has been noticed that the number of patients who test negative before circumcision and positive after the operation has gone up noticeably, provoking questions about the nature of the exercise which was previously reputed to be safe.
She appealed to circumcised men to continue using condoms to reduce the chance of being infected.
“Circumcised men should still use condoms even if their chances of infection have been reduced by circumcision,” Powe emphasized.
Responding to Sunday Standard queries, the SMC National Coordinator, Conrad Ntsuape from the National Aids Coordinating Agency (NACA) said the Department of HIV/AIDS Prevention and Care has made a follow up with the Deborah Retief Memorial Hospital Management to seek clarification on the issue.
 He said the management reported that they have one case of a client who was circumcised in 2010. During the time of circumcision the client was documented as HIV negative. He tested again recently and his results came out positive.
“According to the Deborah Retief Hospital Management, this was reported at the full Council with the aim of encouraging men to continue using other protections as circumcision alone does not prevent infection during sexual intercourse”, said Ntsuape.
He admitted that the latest reports would provoke questions about circumcision adding that the media has a social responsibility against making negative reports about circumcision as this would not help the fight HIV.‘ The Ministry of Health would like to reassure the nation and potential clients of the efficacy of circumcision. It has been proven beyond reasonable doubt through randomized controlled research trials that circumcision as an – add on HIV prevention strategy would help curb the spread of the HIV,” he said.
Ntsuape stated that lower HIV prevalence rates have been found in circumcised men compared to uncircumcised men and three randomized controlled trials in South Africa, Kenya and Uganda have demonstrated a lower risk of acquiring HIV infection in circumcised men compared to those who remain uncircumcised.  
According to Ntsuape, circumcised males have only sixty percent chance of not getting HIV infected when they get into contact with HIV positive females in a sexual relationship.
“This is why the messages given to men who come for circumcision are packaged in such a way that all the intervention for HIV prevention complement each other (abstinence, sticking to one partner, correct and consistent use of condoms and testing for HIV on annual basis, or in case of risky exposure,” he said.
He said Men who opt for circumcision are at all level of contact with the health care provider encouraged and counselled on the importance of practicing safe sex by using condoms, sticking to one partner, or total abstinence for those who are not yet in sexual relationships.
For his part, outgoing Botswana Network on Ethics, Law and HIV/ AIDS (BONELA) Director Uyapo Ndadi said “The question is, are we doing enough to teach people that circumcision does not replace condoms? Are we teaching people that circumcised men can and do get HIV infected.”
He added that “Perhaps our campaigns that target HIV negative men give women the false hope that all circumcised men are HIV negative as well, leading to infections”.
According to Uyapo “We should be concerned by this. I am a proponent of circumcision but messaging is important because if we get it wrong we will end up with cases like these ! We seem to be focusing on getting high numbers of circumcised men and not dealing with empowering the men about issues and myths around circumcision.”

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