Botswana is set to use male circumcision as one of the key factors in HIV/Aids prevention.
This emerged at a recent annual planning conference hosted by the African Comprehensive HIV/Aids Partnership (ACHAP) in Francistown last weekend.
Almost all of the presenters at the conference, including ACHAP Managing Director, Dr. Themba Moeti, were in agreement that while Botswana has, in the past, put a lot of emphasis on ARV therapy, stigmatization and other issues, it is now time to change tactics and emphasize on prevention, with male circumcision as one of the focal points.
Founded by ACHAP in 2005, the annual planning conference has been providing a platform through which ACHAP and its partners and key stakeholders can make assessments and identify strategic priority areas for subsequent planning periods.
The 2008 conference, whose theme was ‘Refocusing HIV prevention: Using Evidence to Inform Future Programming’, marked a culmination of the 2003-2009 national strategic framework for HIV/Aids and the dawn of a new strategic framework to take Botswana to 2016. It was generally agreed that Botswana needs to focus more on, among others, prevention, treatment and care, behavioral change and HIV testing and re-testing.
Prevention is generally perceived to be the priority focus of the future and efforts will be made to scale it up, with a view to establishing a scenario in which there is minimal, if any, new infections.
When presenting on the health sector prevention initiatives, a representative of the HIV/Aids prevention and care department in the Ministry of Health, Mabel Kejelepula, said that male circumcision is an important factor in the drive to prevent sexually transmitted infections and HIV/Aids transmission. It emerged from the conference that the MoH is way ahead as it has already made assessments and developed strategies through which male circumcision can be scaled up. Negotiations between the MoH and medical aid providers and private practitioners have already been initiated and, while there are still some issues to be ironed out, primarily the need for a development partner in the cost sharing process, progress has evidently been made.
Over the years, research has proved that male circumcision significantly reduces the risk of HIV infection. From the conference, it looks like Botswana will embark on a circumcision campaign because medical practitioners generally agree that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional prevention strategy, especially in areas with high prevalence.
Research has shown that males who are not circumcised are at higher risk of contracting sexually transmitted diseases, infant urinary tract infections and penile cancer. Female partners of uncircumcised men are also at greater risk of suffering from cervical cancer.
A private medical practitioner in Francistown said that a majority of men who are HIV positive are infected through the penis.
“In the face of conclusive evidence that uncircumcised men are at a much greater risk of becoming infected with HIV it should be conclusive that male circumcision should be seriously considered as an additional means of preventing HIV,” he said.
Elaborating on how uncircumcised males are prone to infection, the medic explained that the inner surface of the foreskin contains Langerhans cells with HIV receptors which are likely to be the primary point of viral entry into the penis of an uncircumcised man. The foreskin may also have greater susceptibility to tears during intercourse thus providing a portal of entry for pathogens, including HIV.
Although condoms must remain the first choice for preventing the sexual transmission of HIV, they are often not used consistently or correctly. They may break during use and, in some cases; there may be strong cultural and aesthetic objections to using them.
Cultural and religious attitudes towards male circumcision are even more deeply held, but in the light of the present evidence circumcising males seems highly desirable.
In Botswana Bakgatla, through their bogwera and bojale initiation rites, have been at the forefront of male circumcision. After returning from his diplomatic duties in the USA and Canada in 1975 the late Kgosi Linchwe revived bogwera and bojale and even modernized the passing rites as circumcision was done at Deborah Retief Memorial hospital.
While circumcision is generally accepted in Botswana research has shown that only a few men are actually circumcised. This might be because of the fact that circumcision faded to oblivion in the early 20th century because of western influence as it was viewed as some form of genital mutilation. But it seems that Bakgatla, whose leaders, including the recently coronated Kgafela Kgafela, have been redeemed as they have over the years steadfastly stood by their tradition of bogwera and male circumcision. At his recent coronation, Kgafela announced that he will resuscitate their culture and continue his father’s legacy.