Clinic aims to prevent spread of HIV

Male circumcision clinics expected to reduce infection rates in Zimbabwe.

BULAWAYO, Zimbabwe // Well before Zimbabwe's second male circumcision centre opens at the Bulawayo Eye Clinic, in the country's second-largest city, dozens of men have already put their name down for the procedure. "This is a sign that there is a lot of interest among men in Bulawayo," said Kelvin Kaseke, the male circumcision site co-ordinator for Population Services International, one of the government's partners in the project.

The centre was scheduled to open at the end of June, but that had to be delayed as some of the equipment had not arrived and the licences had not been finalised, Mr Kaseke said. "I am hopeful in the next two weeks or so we will start. There are more than 100 people on the list already, so we are very optimistic that when we finally open, more will come." Zimbabwe, with an HIV prevalence rate of 15 per cent, among the world's highest, has identified male circumcision as another weapon in its multi-pronged fight against the Aids pandemic. The first male circumcision centre in Harare was opened earlier this year with another three scheduled to open this month, including at the Bulawayo Eye Clinic, at the Mutare Provincial Hospital in eastern Manicaland province and at the Karanda Mission in northern Mashonaland in Central province.

"It's a free service so even poor people like me can access it. I will go for it," said Rowan Chinoputsa, 25, a security guard. Three randomised trials by the World Health Organisation in South Africa, Uganda and Kenya between 2002 and 2007 showed that the risk of contracting HIV through unprotected heterosexual sex was 65 per cent lower among circumcised men than among uncircumcised ones. The world body notes that circumcision could save three million lives and prevent 5.7m new cases in sub-Saharan Africa over 20 years.

Shortly after the findings of the first study were released in South Africa in 2005, Medical News Today, a UK-based medical news journal said circumcision was a cheaper option to combat HIV and Aids. "The procedure can be carried out at US$55 [Dh202] per man. This compares to $2,400 in future medical costs to treat a recently infected person in Africa," it said. So poorer countries in southern Africa, such as Zambia, Zimbabwe, Swaziland, Malawi, Lesotho, Mozambique, Botswana and South Africa - the worst affected by the global pandemic - view circumcision as a viable option.

Mr Kaseke expects the Bulawayo clinic to be as busy as the Harare one, with between 15 and 20 circumcisions daily. "The whole process covering counselling and administration of anaesthetics," he said, "takes one and a half hours, but the actual operation takes around 15 minutes. After that we expect the wound to heal within six weeks." Data from Zimbabwe's National Aids Council (NAC), a statutory body that co-ordinates programmes against the disease, indicates that about 10 per cent of Zimbabwean men are circumcised.

Although circumcision gives only partial protection against HIV/Aids, it also helps to prevent cancer of the penis, urinary tract infections in children and cervical cancer in women, the NAC says. "Because male circumcision does not provide complete protection," it notes, "circumcised men should continue to use other HIV prevention strategies, including abstinence, reduction in the number of sexual partners, correct and consistent use of male and female condoms and knowledge of status."

Population Services International and the US Agency for International Development are supporting the project. "I heartily support this important intervention," said James McGee, outgoing US ambassador to Zimbabwe, touring the pilot centre in Harare in June. "Unlike other prevention methods, male circumcision is a one-time procedure that provides lifelong protection." Among the Shona and Ndebele tribes, which constitute 92 per cent of the national population, circumcision is limited, according to the NAC.

However, minority tribes such as the Shangaan, Xhosa, Venda and Tonga communities circumcise their adolescent men as part of the rites of adulthood. Henry Madzorera, the minister of health and child welfare, was hopeful that because the operation is free, more men would undergo the procedure. He said before the dedicated clinics were set up, hospitals offered the service to a limited number of men, for a fee.

Cleopas Mhlanga who underwent the operation in April told local weekly Sunday News recently; "I urge all men to go for it; prevention is after all better than a cure. If there is even a minor chance that you can prevent getting infected with HIV and other sexually transmitted diseases, then they would be clever to go for it." [e-mail]