Circumcision and AIDS in Uganda

Eight men are sitting in the waiting room at the Rakai health center. They range in age from 18 to 61. They’re all here — to get circumcised.

This man says he wants to protect himself against disease. Diseases like AIDS. When I ask, what about condoms?

Some of the men say they already use condoms. They want to be circumcised as a backup.

In Uganda, most men aren’t circumcised. They’re part of the Christian majority. About ten percent of Ugandans are Muslim. They have their sons circumcised as infants.
But these men in Rakai are getting the surgery as adults. It’s largely because of recent research. Studies suggest circumcised men have a 60% reduced risk of contracting HIV. Some of the research was done in Rakai.

Godfrey Kigozi overseas the male circumcision studies here. He says they’re now offering the procedure to all men in this rural community and the response has been overwhelming.

�We can’t circumcise everyone who turns up. We’re scheduling up to one month. So people are turning up. We’re doing about 15 day.�

The surgery’s free. It’s paid for by the US government, under President Bush’s program for AIDS treatment and prevention. The men also receive about $3 to compensate them for losing a day or two of work.

Not everyone’s eager to get the surgery. Many find the idea of circumcision alien, even a little threatening.

Dr. Jackson Musuuzu has performed some 800 circumcisions in the past two years.

He says when he and others first approached men here with the idea of getting circumcised, some Christians said they feared it would turn them into Muslims.

“but we made it very clear to the people that we see that this will not turn you into a Muslim. It is just a procedure. ..”

A medical procedure. But circumcision is also a religious and cultural issue. And that makes it sensitive for public health officials. Dr. Sam Zaramba is with Uganda’s Ministry of Health.

He says he’d like to launch a national campaign to get more men here circumcised … as other African countries have done. Like Rwanda for instance, and Swaziland, which has kept clinics open on weekends for “circumcision Saturdays.”

“Other countries, like our neighboring countries have started to roll it out. They’re doing very well. And actually, since the studies were announced, we are seeing an increase in male circumcision. But of course, we still have uh some people who are doubting thomases.”

The main doubting Thomas is Uganda’s President, Yoweri Museveni.

He’s been a major supporter of Uganda’s prevention strategy — the one that emphasizes abstinence, faithfulness and condom use. But he doesn’t support male circumcision.
Museveni recently told a group of Western reporters he wants evidence it “armors” men against AIDS — the way a tank is armored against bullets.

“I would like to get the science of all this. I have not bothered with it because my views are sort of made up… Maybe I will go and study. Hmmm. But those are my preliminary views.”

HIV experts say some of Museveni’s concerns are warranted. Circumcision doesn’t provide complete protection. Doctors say men still need to use condoms…. and they still need to reduce the number of sexual partners. There’s a lot of information to communicate. And getting the message right is important.

Isaak Simba and his band mates call themselves the Circ Squad. Simba says they all got circumcised last summer and they wrote this song to answer some common questions.

“Everyone asks you the question, so doesn’t it hurt, so what, I have to put on a dress, and the thing is, everything is in the song. If you take your time, and listen carefully, you’ll get everything there, because we advise you accordingly (heh heh)”

“It can be painless, harmless, and brother you know what? You can be right back at your job, with your pants on like you …., but best of all, you don’t need a sick holiday….

Despite the push to promote circumcision, Uganda’s not really ready to roll out a national program. For one thing, the country doesn’t have enough trained surgeons. And there’s something else that may prove a bit of a hurdle. Men are supposed to abstain from sex for six weeks after the surgery.

If they don’t, they could actually increase their risk of HIV infection. Isaak Simba says when he told his new girlfriend about his plan to get circumcised, she was less than enthusiastic.

“She was like, are you crazy, six weeks? You know, we had just started dating… And I was like, yeah I think, new relationship, new life… (laughing) and she was like, well, I’m ready for it…. So I went for it.”

For The World, I’m Jennifer Goren, Rakai, Uganda.