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A Q&A with a doctor directing circumcision programs across southern Africa.
Editor's note: Africa has the world's largest number of HIV infections and AIDS cases. Across the continent the disease is being battled with public education and antiretroviral drugs. A new additional strategy is male circumcision. Several tests show that circumcised men have substantially reduced risks of contracting HIV. In response, several campaigns have been launched to circumcise men.
GlobalPost has investigated this public health effort in eastern and southern Africa. The series starts in Kenya in the fishing villages by Lake Victoria and includes a video of a circumcision. Also, a Kenyan doctor describes his work running a circumcision clinic and health writer Mercedes Sayagues gives her controversial opinion on the issue.
JOHANNESBURG, South Africa — Male circumcision programs aimed at preventing HIV transmission are expanding and gaining greater acceptance across southern and eastern Africa.
In a Q&A with GlobalPost, Dr. Dino Rech, regional clinical consultant for Population Service International/Society for Family Health, discusses his experiences in scaling up male circumcision programs across southern Africa, including in Zambia, Swaziland, South Africa and Zimbabwe.
Dr. Rech was previously the medical manager of South Africa’s Orange Farm site — the location of an early male circumcision research trial — where he managed the clinical side of a scale-up program that expanded male circumcision services in the township.
GlobalPost: Can you give a sense of the different views towards male circumcision that you have encountered in southern Africa?
Rech: From my perspective the public views change from place to place and depending on the amount of advocacy and exposure people have had to the research. Normally when you go into countries or programs that are new and you’re talking to new politicians and new ministries of health, there’s a lot of skepticism. People think to themselves, 'Well, how can this work? How does removing some skin make any difference to a person’s chance of getting HIV?' But when you show them the observational data from Africa, when you show them the data from the randomized control trials, when you explain the biological and mechanical mechanisms — the removal of the receptor cells, and the keratinization of the skin, which makes it less likely to be susceptible to bruises when you have intercourse and hence infection — then people start to come around slowly.
Obviously you’ve got feminist groups that are worried that men will get circumcised and then pressurize women to have sex without a condom. But you try to convince them that this [male circumcision] happens as part of a complete package. People get counseled twice, three times, four times even before they can undergo the procedure. They get counseled at two follow-up visits. People get a huge amount of information telling them that this is not full protection, it’s just partial protection as part of an HIV program.
A lot of countries, like Botswana and Zambia, have the football analogy. The goalkeeper is male circumcision, so he’s the last line of defense, but in front of him you’ve got your defenders: monogamous relationships, condomizing, knowing your status … You’ve got a defensive wall — the normal preventative measures — and then circumcision is your goalkeeper if something goes wrong.
Generally people are cautious at first, but with more information and education most countries are coming around. Even the lobby groups against male circumcision are slowly starting to understand that we’re not just chopping off thousands of foreskins. You need large counseling teams, large support teams, large follow-up teams, emergency services teams, that all support this initiative.