The fringe benefits of male circumcision rollout

James Nango discovered he had syphilis when he visited a clinic in his home town of Kisumu, in western Kenya's Nyanza Province, in 2009, hoping to be circumcised as a way of reducing his HIV risk.

"I used to have an itch on the tip of my penis but I did not know what it was... I thought it was just some rash that would disappear," the 26-year-old told IRIN/PlusNews. "I only knew it was syphilis when the doctors at the clinic told me that I couldn't be circumcised unless it was treated."

At the clinic, Nango also had his first HIV test; he was found negative and following a successful course of treatment for his sexually transmitted infection (STI), he was circumcised.

In November 2008, Kenya launched an ambitious national voluntary male circumcision drive, which aims to have more than one million men circumcised by 2013 The government's effort is largely concentrated on Nyanza Province, where fewer than 50 percent of men are circumcised and the HIV prevalence is 15.4 percent, about twice the national average. A recent rapid results initiative saw more than 35,000 Nyanza men circumcised within a six-week period.

The circumcision programme provides voluntary counselling and testing for HIV and routine STI tests to all men who seek the services. According to the government, more than 75,000 men have been circumcised since its launch.

Charles Okal, provincial AIDS and sexually transmitted infections control officer, said most people in Nyanza only sought treatment for STIs in the advanced stages. Government figures put the prevalence of genital herpes in Nyanza at 49 percent, and that of syphilis at 2.4 percent.

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"STIs are a risk factor in HIV infection and we are happy that most of those seeking circumcision are treated when found to be infected," said Nicholas Muraguri, director of the National AIDS and Sexually transmitted infections Control Programme. "Medical male circumcision also provides partial prevention of the HPV virus, responsible for cervical cancer in women, which is a leading killer of women with HIV, especially in rural areas."

According to Walter Obiero, a clinical manager at the Nyanza Reproductive Health Society (NRHS) - one of the partners in Kenya's Voluntary Medical Male Circumcision Consortium - the programme's benefits extend well beyond the procedure.

"They get the benefit of being treated for these [sexually transmitted] infections once they drop in at the clinics to receive medical male circumcision," he said. "For married couples, for instance, such a benefit is two-fold because once these infections are detected early in a man, then they are treated in time before the woman gets infected or if she too is infected, then she gets to be treated as well."

The programme also involves sessions on condom awareness. "When you teach people how to use condoms, give [them some] to take home, then the message that male circumcision only works together with other HIV prevention strategies is better reinforced," Obiero said.

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