MALAWI: Genital cutting is undermining condom use

The Maravi Post (Malawi)
August 30, 2015

Is voluntary male medical circumcision de-campaigning Condom use?

by da Kazembe
Blantyre, August 29, 2015: Seventeen-year-old Homic Muluwani of Bangwe Township is excited that at last he has had the most taunted voluntary male medical circumcision (VMMC) which to him certifies him to having unprotected sex now that he presumes he will be safe.

He is one of the more than 2000 males circumcised in the recent VMMC campaign which according to the Blantyre district VMMC coordinator, Jean Mhango was a success.

Much as the figures indicate the campaign as being successful, it is the mindset of the VMMC clients which seem to defeat the intended purpose for VMMC which is 60 percent risk reduction of HIV infection in HIV negative males who undergo the procedure.

Homic Muluwani and his friends tell the dangerous story as they wait for their turn to get circumcised at South Lunzu VMMC camp.

“I have had a girlfriend for the past two years and we have been having protected sex for fear of the HIV virus but this time I am going to enjoy unprotected sex since I am sure of my safety following the medical circumcision,” says Muluwani.

The 60 percent HIV risk reduction that follows after VMMC is surely misconceived in most males who are flocking for the procedure for they take it as a guarantee to having unprotected sex.

This leads to the query as to whether condom use is not being de-campaigned by VMMC promotion.

The Ministry of Health spokesperson, Adrian Chirumba says much as the opinion may arise from such sentiments, a study has not been carried out to validate this.

“Our implementing partners in VMMC such as Banja La Mstogolo (BLM), Population Services International (PSI) also have no records to validate the opinion,” says Chikumbe.

According to PSI one of the Ministry of Health’s implementing partners in VMMC, Malawi is working to scale up 605 coverage of male circumcision among negative males ages 10-34.

PSI national communications coordinator for VMMC, Lionel Chipeta points out that Malawi is working to scale up to 60 percent coverage of male circumcision among HIV-negative males aged from 10 to 34.

“VMMC is recognized as a high priority intervention in the Malawi National HIV and Aids Strategic Plan 2015-2020 and the National HIV Prevention Strategy 2015-2020,” explains Chipeta.

Martha Kamela of Mbayani Township finds her husband is better off uncircumcised due to the same misconception of the 60 percent risk reduction for she thinks once he is circumcised he will be at liberty to have unprotected sex with other females.

“Since my husband will know that he is safe from contracting the virus, chances are he will be cheating more as compared to now where he is afraid of contracting the virus,” says Kamela.

Kamela states that most men want to go under the knife as a guarantee to go and have unprotected sex without fear.

According to the VMMC South Lunzu site supervisor, Joseph Mdzinga, males aged between 10 and 19 patronized the services.

Looking at the age group, one can easily conclude that those accessing VMMC are still in the youthful exploring age hence the danger in the misconception.

The World Health Organisation HIV prevention package includes Abstinence Being faithful and Condomise (ABC), Post Mother to Child Transmission (PMTCT) as well as VMMC and if the later seems to be defeating the condom use as per the perception, one wonders whether VMMC will yield the intended results, come 2020.

ZIMBABWE: Circumcised men refuse condoms, get HIV

Is anyone surprised?

The Standard (Zimbabwe)
November 10, 2013

Circumcised men indulge in risky sexual behaviour

SOME circumcised men are contracting HIV and Aids after ditching the use of condoms, under a misguided belief that male circumcision (MC) would prevent them from getting infected, The Standard has heard.

This revelation comes at a time when the national programme is battling for recognition and relevance as an effective preventive tool for HIV and Aids in the country.

Sex workers who spoke to The Standard last week said some circumcised men were no longer using preventive methods, including condoms, because they believed that their chances of getting infected were limited after getting circumcised.

One of the sex workers, who only identified herself as Memory told a United Nations Populations Fund (UNFPA) media training workshop in Bulawayo last week, that most of her circumcised clients were not willing to use condoms.

“I have problems with circumcised men because they do not want to use condoms. They always argue that because they have been circumcised they did not need to use condoms,” said the heavily pregnant Memory, who is also HIV-positive.

Memory said even after disclosing her HIV status, they still insisted on sleeping with her without any form of protection.

“I even take my antiretroviral drugs in their presence but they do not care and because I have a family to feed, I give in to their demands,” said Memory.

But Ministry of Health and Child Care national male circumcision coordinator, Sinokuthemba Xaba maintained that the procedure reduced chances of getting infected by at least 60%, but urged men not to stop using condoms.

He defended the programme saying it was a pity that some people were under the misguided opinion that by being circumcised they would not be infected.
[More than a "pity" - it's a total disaster.]

“MC is still an effective tool and circumcisions avert HIV-infection but circumcised men can still get HIV,” Xaba said.

According to the 2010/2011 Zimbabwe Health Demographic Survey (ZDHS), 14% of circumcised men in the country between the ages of 15 and 49 years contracted HIV as compared to those uncircumcised.

[Was this deliberately garbled? What is missing is “..as compared to 12% of those uncircumcised.” A 2005 survey found 16.6% and 14.2%.. In other words, circumcision has conferred no protection whatsoever on the men surveyed.]
Critics have dismissed claims that MC prevents contraction of HIV by at least 60% saying it was “exaggerated”.

Meanwhile, the uptake of the MC remains low with most provinces recording less than 10% uptake.
...

LEXINGTON, KY: Intact men more likely to use condoms

Intact men use condoms more, and more confidently

This paper is also ground-breaking using the word "intact".

Int J STD AIDS. 2013 Mar 20. [Epub ahead of print] A comparison of condom use perceptions and behaviours between circumcised and intact men attending sexually transmitted disease clinics in the United States.

Crosby R, Charnigo RJ.

Abstract
This investigation compared circumcised and intact (uncircumcised) men attending sexually transmitted infection (STI) clinics on condom perceptions and frequencies of use. Men (N = 316) were recruited from public clinics in two US states. Circumcision status was self-reported through the aid of diagrams. Intact men were less likely to report unprotected vaginal sex (P < 0.001), infrequent condom use (P = 0.02) or lack of confidence to use condoms (P = 0.049). The bivariate association between circumcision status and unprotected sex was moderated by age (P < 0.001), recent STD acquisition (P < 0.001) and by confidence level for condom use (P < 0.001). The bivariate association between circumcision status and infrequent condom use was also moderated by age (P = 0.002), recent STI acquisition (P = 0.02) and confidence level (P = 0.01). Multivariate findings supported the conclusion that intact men may use condoms more frequently and that confidence predicts use, suggesting that intervention programmes should focus on building men's confidence to use condoms, especially for circumcised men.

PMID: 23514832 [PubMed - as supplied by publisher]

LEXINGTON, KY: Circumcised men less likely to use condoms

PubMed
March 20, 2013

Intact men more likely to use condoms

This study shows circumcised men are less likely to use condoms at all, more likely to use them rarely, and lack confidence in using them.

Int J STD AIDS. 2013 Mar 20. [Epub ahead of print] A comparison of condom use perceptions and behaviours between circumcised and intact men attending sexually transmitted disease clinics in the United States. Crosby R, Charnigo RJ. Source College of Public Health at the University of Kentucky, Lexington, Kentucky, USA. Abstract This investigation compared circumcised and intact (uncircumcised) men attending sexually transmitted infection (STI) clinics on condom perceptions and frequencies of use. Men (N = 316) were recruited from public clinics in two US states. Circumcision status was self-reported through the aid of diagrams. Intact men were less likely to report unprotected vaginal sex (P < 0.001), infrequent condom use (P = 0.02) or lack of confidence to use condoms (P = 0.049). The bivariate association between circumcision status and unprotected sex was moderated by age (P < 0.001), recent STD acquisition (P < 0.001) and by confidence level for condom use (P < 0.001). The bivariate association between circumcision status and infrequent condom use was also moderated by age (P = 0.002), recent STI acquisition (P = 0.02) and confidence level (P = 0.01). Multivariate findings supported the conclusion that intact men may use condoms more frequently and that confidence predicts use, suggesting that intervention programmes should focus on building men's confidence to use condoms, especially for circumcised men. PMID: 23514832 [PubMed - as supplied by publisher]

Since condoms are so much more effective than circumcision at prevening HIV acquistion and transmission (assuming the RCTs are valid) this just underlines the risk of promoting circumcision.