SOUTHERN AFRICA: Male circumcision - what's the latest?
Young boys rescued from an illegal initiation school in Orange Farm, South Africa
JOHANNESBURG, 23 June 2009 (IRIN) - It has been two years since the World Health Organization recommended male circumcision (MC) as an HIV prevention measure, and countries in Southern Africa - the region hardest-hit by AIDS - have been slowly gearing up to provide widespread access to the procedure.
IRIN/PlusNews has compiled a list of the progress made so far in eight southern African countries.
Botswana's Ministry of Health has set a target to circumcise 80 percent of eligible men, or about 460,000, by 2012. Initially, the procedure was rolled out to 26 public hospitals, but at the beginning of 2009 less than 20 percent of males had access to MC services, according to the US President's Emergency Plan for AIDS Relief (PEPFAR).
In April, a further six public clinics and 17 private clinics began providing circumcision, the Botswana Press Agency reported.
Male circumcision services are still limited, with about 4,000 men circumcised annually through a mix of government clinics and NGOs such as Christian Health Association (CHAL) and the Lesotho Planned Parenthood Association.
A national strategy on male circumcision is being developed. Male circumcision done in the health sector would cost about USD$56 per procedure, UNAIDS has found.
As of December 2008, the country was conducting research to review feasibility, cost implications and cultural issues.
A national task force on male circumcision and HIV prevention has been established, according to UNAIDS.
The procedure is currently offered at some state hospitals. The country has completed a situation analysis to understand the attitudes, impact, and resource implications of implementation.
A Male Circumcision Task Force and a Male Circumcision action plan is due to be presented to parliament this year.
Activists have been frustrated by the government's lack of urgency in introducing MC. The government announced recently it was assessing how to make it part of its HIV prevention programme. The move comes after extensive consultations with the National AIDS Council as well as traditional leaders.
The only facility in the country offering the procedure free of charge is the Bophelo Pele centre in the township of Orange Farm - the site of one of three randomised controlled trials that confirmed MC's protective effect against HIV.
Swaziland was one of the first countries to implement "mass" male circumcision, and by the end of 2008 had circumcised more than 2,000. But inadequate capacity meant a low key campaign to avoid over demand.
The country is expected to receive a 5-year US$50 million grant to scale up this year through the Bill & Melinda Gates Foundation, which aims to extend the procedure to 650,000 men in Zambia and Swaziland.
In June 2009, the government announced they were working on a plan to reach 50 percent of all men and 80 percent of all new born babies by 2020.
The government offers MC at the University Teaching Hospital in the capital, Lusaka, the General Hospital in Livingstone and satellite facilities in the rest of the country.
Although donors have pledged resources, the country has been slow to take up the campaign. At the recent HIV/AIDS Implementers’ Meeting held this month in Namibia, government officials reported the country had so far performed only 140 circumcisions through state facilities. The Ministry of Health, however, is set to open male circumcision clinics in Bulawayo, Mutare and Mt Darwin by the end of June and is currently training physicians to conduct the procedure.