Government finally moves on male circumcision

Clement Zulu never thought he would be circumcised. A Christian from the north of Malawi, Zulu was among millions of Malawians who believed the practice was a ritual for the southern Yao people, who are mostly Muslims.

But after reading a newspaper article in October 2011 stating that Malawi had adopted medical male circumcision as part of its HIV prevention strategy and would begin providing the service, the 34-year-old had a change of heart. Zulu is now one of the many to have undergone the procedure free at state hospitals.

“Having lost my three relatives to HIV/AIDS I decided to take some precautionary measures that would [help to] prevent me from being infected," he told IRIN/PlusNews.

According to the Principal Secretary for HIV/AIDS in the Office of the President and Cabinet, Mary Shawa, more than 5,000 men have so far been circumcised - an "encouraging" figure given that only 4 percent of the country's medical staff have been trained to carry out the surgical procedure.

“Being a [member of the] medical [profession] does not mean that one automatically knows how to [perform] circumcisions. So there are special courses that [have to be] taken regarding the circumcision,” she told IRIN/PlusNews.

The campaign hopes to circumcise more than 250,000 men by 2015, said National Sexually Transmitted Infections Programme Officer in the Ministry of Health, Amon Nkhata.

As one of the countries hardest hit by HIV/AIDS, Malawi has been criticized for moving too slowly in introducing free male circumcision in state facilities. Results from three randomized clinical trials released in 2005 and 2006 provided compelling evidence that circumcision can reduce a man's risk of HIV infection during heterosexual intercourse by as much as 60 percent.

The World Health Organization endorsed the procedure as an HIV-prevention measure in 2007, but implementation of a large-scale male circumcision programme in Malawi has been controversial in the conservative country.

Southern Malawi, where most circumcisions take place, has a large migrant labour population and an HIV prevalence rate of about 18 percent, accounting for almost 70 percent of the country's HIV infections, according to government figures. Circumcision is culturally less prominent in northern Malawi, where prevalence rates are also lower.

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The disparity between HIV prevalence and traditional circumcision rates has raised doubts among some health officials, who argued in local newspapers that they had not yet been presented with enough clinical evidence, and the efficacy of male circumcision was questionable given high HIV prevalence rates among traditionally circumcising populations in the south.

But the government formally launched its voluntary medical male circumcision programme last year in Mulanje district, which has an estimated HIV prevalence of 17 percent. Mulanje is one of nine pilot districts to offer the service.

“Malawi had also conducted its own study which also proved the efficacy of male circumcision in reducing the spread of the virus that causes AIDS," said Ministry of Health spokesman Henry Chimbali.

The government has embarked on an intense campaign to disseminate accurate information about medical male circumcision. Malawi registers 70,000 new infections a year, and people still had to be reminded that male circumcision alone is "not 100 percent safe", Chimbali cautioned.

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