More than 380,000 Ugandan men have been circumcised in the last two years as part the government's HIV-prevention efforts, new statistics reveal.
Uganda's male circumcision programme was launched in September 2010, targeting 80 percent of uncircumcised men - about 4.2 million men - by 2015. According to the Uganda AIDS Commission's (UAC) annual performance review of the National HIV/AIDS Strategic Plan (2011/2012), 380,000 men were circumcised by March 2012 under the programme.
Just over one-quarter of Ugandan men are circumcised, but the US President's Emergency Plan for AIDS Relief (PEPFAR) and UNAIDS together project that circumcising 4.2 million Ugandan men could halve the country's HIV incidence.
Recent statistics show that Uganda's HIV prevalence has risen from 6.4 percent to 7.3 percent over the past five years.
The government says it hopes to circumcise one million men each year for the next three years.
"We are going to scale-up SMC [safe male circumcision] as a key component in the core package of a combination of HIV prevention services. I have given myself a target to circumcise one million adults annually," SMC National Coordinator Barbara Nanteza told IRIN/PlusNews. "I am working closely with the implementing partners to roll out SMC services through surgical camps, outreach and mobile teams."
"PEPFAR has given us funds to circumcise 750,000 men. We will mobilize other funds from the government, UN agencies and partners," she added.
Nanteza said the government was considering lowering the target age to 12, hoping to reach boys and their parents during school holidays.
|The scramble for numbers should not overshadow the need to deliver quality male circumcision services|
While the progress is impressive, outpacing neighbouring Kenya, where 477,000 men have been reached in four years, critics say it may be difficult for the government to meet its targets unless it significantly expands and speeds up the programme.
"The scale-up of medical male circumcision, a critical element of combination HIV prevention, is slow and has been undermined by lack of government support," HIV civil society organizations said in a 16 October 10-point plan to halt new infections and save lives.
The UAC acknowledges that, since the programme's launch in 2010, it has not been formally scaled-up nationally, and effective linkages between SMC and other HIV services have not been put in place.
"The coverage is still low because of a host of challenges. SMC was adopted as a programme, but no budget has been allocated. Health facilities were asked to start circumcision without additional resources, including supplies," Richard Hasunira, HIV/AIDS adviser for the health rights group Coalition for Health Promotion and Social Development (HEPS)-Uganda, told IRIN/PlusNews. "The circumcision effort that has so far been seen is driven by non-governmental partners and donor agencies, and their effort is not effectively coordinated."
The civil society activists said there was a need for the country's political leaders to unify their messaging when it came to male circumcision, otherwise they risk confusing the public about the government's position. President Yoweri Museveni has himself been a frequent critic of male circumcision as an HIV-prevention measure.
"Political leaders should show support for the evidence and stop disparaging safe medical male circumcision with misleading comments," the organizations said in their plan. "SMC is a core part of effective, evidence-based combination prevention, and the policymakers who ignore that are exposing their own lack of commitment to ending the epidemic and saving lives.
"Women must be involved at all levels of policy development and implementation to ensure there is no misinformation or unintended consequences for women, who are not directly protected by this intervention," they added.
Convincing men in a largely non-circumcising country to accept the procedure will be an uphill battle for the ministry; according to Uganda's 2011 AIDS Indicator Survey, about 50 percent of men are unwilling to undergo the procedure.
Scaling up the programme will also be difficult in a public health system where just 63 percent of health worker positions are filled. In the districts where the programme has been launched, stock-outs of SMC kits are common. In addition, the health ministry has not developed a framework for monitoring and evaluating the programme.
"Efforts should be made to rapidly scale-up SMC within the formal health sector and in the context of the district health system. The scramble for numbers should not overshadow the need to deliver quality SMC services," a ministry official, who preferred anonymity, said.