Tuesday, August 9, 2022

Circumcision remains Botswana’s last hope to reduce HIV/AIDS treatment costs

The Program Director at ACHAP, Dr Frank Muangeni, says, if successful, the ongoing Safe Male Circumcision campaign has the potential to reduce the high costs that government incurs through buying drugs that treat a majority of people that are HIV positive.

ACHAP is the African Comprehensive HIV/AIDS Partnerships that enjoys a generous patronage from the American government.

Speaking to Sunday Standard, Muangeni said statistics show that for every eight circumcisions, “we avoid one HIV infection”.

To put the statistics into further perspective, Muangeni said while $25 million would be needed to circumcise a targeted number of just below 400, 000 people, treating the same number through HIV/AIDS drugs would cost a whopping $316 million.

“We have to reduce new HIV infections. Treating HIV/AIDS is too costly. Circumcision reduces costs,” he said.

Government, through President Ian Khama, has on a number of occasions reminded the country that free-anti-retroviral programme that is financed through public finances has become unsustainable.
When Safe Male Circumcision programme started in 2009, the target was to run it until 2016, by which time it was hoped 80 percent of men in Botswana would have come forward which would have resulted in drastic decline of HIV infections, and with that costs too.

Reality has, however, proved much more difficult than that which is why ACHAP and their partners are currently reviewing not just their targets but also the possibility of extending the programme beyond 2016.

The goal, said Dr Muangeni, remains achieving a target that culminates into a public health benefit by way of reducing new HIV infections.

That can only be realized if a sufficiently high number of men are circumcised, he said.
“Benefit of circumcision moves from person to community. There is a direct relation between not-circumcising and high cervical cancer deaths among women. We can only change these through information,” said Dr Muangeni.

He is quick to concede that while there is improvement in the uptake, with a greater number of people now joining the ranks that accept circumcision as the way to go, it has been slow, costly and a painstaking journey.

This has resulted in much higher amounts of money spent to circumcise comparatively smaller numbers of men.

Compared to Kenya, which is often touted as Africa’s poster card example of success when it comes to circumcision, Botswana spends almost five fold to achieve the same results as Kenya’s.

“We have come from far and a lot has been achieved. When you get to think that in Kenya it costs $100, in Botswana it was initially as high as $500 before it went down to the current $118. While we initially spent more, owing to growing acceptance the costs have gone down,” said Muangeni.

Even then there is evidence that such evidence is only limited to school-going age brackets up to a maximum of 24 years, beyond which resistance cannot be mistaken.

“Public health survey shows that men do not like to go to hospital because they fear pain, hence resistance. But the circumcision procedure is totally painless,” he said as a matter of fact.
It is not clear if the United States government will fund the Safe Male Circumcision program beyond the current $25 million tranche.

This was after there were concerns raised from the donor community that owing to low acceptance rates, circumcision costs among Botswana men were so high as to defeat the purpose.

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