Win32 Virus Removal

WHAT has been known as male circumcision (MC) is now in the medical circles being referred to as Voluntary Medical Male Circumcision (VMMC).

This refers to the surgical removal of the foreskin that covers the head of the male sexual organ, and is mainly carried out for medical, religious and cosmetic purposes.

MC, which has been a practice from ancient times by some religions and cultures, is being supported not only by the World Health Organisation (WHO), but promoted by the Ministry of Health, as one of the prevention strategies against the spread of HIV/AIDS.

A renowned HIV/AIDS activist, Mannasseh Phiri said if well implemented in Zambia along with other prevention interventions, MC could give impetus to the country’s goal of reducing the prevalence rate from 14.3 per cent, to less than five per cent, by 2015.

"If in Zambia we can circumcise two million men by 2015 and could circumcise 80 per cent baby boys at birth, we could curb the spread of HIV/AIDS by great magnitudes in the next 20 years," Dr Phiri said.

In as much as people may hold a diverse view on the advantages of MC, overwhelming scientific evidence had indicated that the practice offers about 60 risk reductions for HIV/AIDS infection.

British Broadcasting Corporation (BBC) World Service Correspondent, Kennedy Gondwe, shares personal chronicles of his experience behind the life- changing medical MC.

This of course, came as a result of his interest of using his journalistic skills (power of the pen) to educate the masses on MC as an HIV/AIDS prevention measure.

Like many other scribes do, he checked his wide contact base, and the name that immediately came to Kennedy’s mind was that of Dr Phiri.

He was advised by Dr Phiri that if he himself (Kennedy) could undergo MC, he would write a story based on a personal life experience and it could inspire many other men to undergo MC as a way of stemming the spread of HIV/AIDS.

"He asked me if I was circumcised, and I said no. He asked me if I would want to undergo MC, and my initial reaction was mixed, until I embarked on wide consultations from family and friends.

"My family were very supportive, especially after I informed them that I had intentions of going public about it.

"With my friends, the feelings were mixed. Friends from traditionally circumcising tribes such as the Luvales saw my intentions to go public as sacrilegious, because they believed MC was supposed to be a sacred practice," he narrates.

"At this point in time, my mind was made up, and nothing was going to stand in my way, after all, my girlfriend was very supportive of my decision.

"Having been privileged by the nature of my job, I knew what exactly to expect. I had all the information I needed to know, prior to the operation.

"On the material day, I decided I was going to record the series of events leading to my operation, for a BBC radio documentary.

"Just as I figured it out, I was first counselled and tested for HIV/AIDS and I was told the result was negative. I was assessed for medical and physical, then led to the operation theatre, where to my greater surprise, was received by a female nurse, who asked me to undress.

"This made me feel slightly uncomfortable, because I could not bear the thoughts of undressing in front of a female. But I soon came to terms with it, and in no time I was injected with local anaesthesia, at the base of my manhood, after which, it became numb.

"The operation went on for about 30 minutes, during which I chatted with the people who were conducting the operation, because I could not feel any pain.

"After the operation, I was counselled on how to clean myself. The healing takes a few days, but of course the complete healing is about six weeks.

"After the operation, the documentary was aired on BBC radio and Hone Radio, where I got both negative and positive reactions, but I knew I would draw a lot of interest, especially on the international front. Others laughed and ridiculed me, but they secretly went ahead for MC.

"I believe the documentary inspired students at Evelyn Hone College, journalists and other men to consider MC as an HIV/AIDS prevention measure," he recounted.

Asked about concerns raised about the enjoyment of sexual intercourse, after undergoing MC, he responded by saying he still enjoyed it very much, and that stories of reduced sexual sensation were not true.

Asked on how he coped with the healing, he responded by saying the pre-counselling information was very helpful.

"If you are determined to stem the spread of HIV/AIDS and other STI’s, then MC is a decision worth taking," he said.

Dr Phiri said figures backing the efficacy of MC as a prevention intervention were arrived at after clinical trials were conducted simultaneously in Kenya, Uganda and South Africa in the last decade.

In total about 11,000 men were recruited in the trials. Half were circumcised and half were not. All were followed up regularly with counselling and supplied condoms.

About 18 months into each of the trials, they were halted because it was quite clear that more HIV/AIDS infections were occurring in the uncircumcised men.

Following this compelling evidence, WHO made recommendations in 2008 that those countries with high prevalence needed to incorporate MC as part of their prevention interventions.

In Zambia, the National AIDS Council (NAC) has identified that of the six major drivers of HIV/AIDS infection, low levels of circumcision among our men is the third major driver of the spread of the disease.

Against this background, the Government has taken a bold decision to scale up MC.

"But to achieve goals of reducing the spread of HIV/AIDS through MC, at least two million men need to be circumcised by 2015, meaning that about 400,000 males should be circumcised annually by 2015," Dr Phiri said.

In 2010 alone, only 160,000 medical MCs were recorded countrywide, this represents less than half of the required annual desired figures.

There is therefore an urgent need for all sectors of society to be involved in promoting MC.

Having realised that the fight against HIV infection was a collective responsibility, certain traditional leaders from non-traditionally circumcising tribes have taken it upon themselves to encourage their subjects to undergo MC as a prevention strategy.

Notable among these is Paramount Chief Mpezeni of the Ngoni people, who decreed at the N’cwala traditional ceremony of 2011 that MCs were to be restored as Ngoni traditional rite and that from now on, all Ngoni adolescent boys of 14 years and older, to undergo circumcision but that should be done by medically trained experts.

Historically, Ngonis hail from King Shaka’s kingdom and circumcision was a tradition there until Shaka stopped it over 200 years ago.

Another traditional leader who has taken keen interest of promoting MC as an HIV prevention measure, is Senior Chief Mumena of the Kaonde people, who has been encouraging his subjects to consider MC as a means of curbing the spread of the virus.

Chieftainess Nkomeshya Mukamambo said publicly at the recent HIV Prevention Convention that she would encourage the men in her chiefdom to undergo VMMC.

"If only we could have more chiefs encourage MC, we will be able to achieve the country’s goals of reducing the spread of HIV/AIDS. MC is no longer about tradition, or religion. It is about HIV prevention," Dr Phiri said.

The scientific explanation of how MC relates to HIV prevention was the foreskin that covers the manhood is softer and more fragile on the inside, making it more prone to bruising, which provides easier access for infections.

Dr Phiri said apart from being soft and bruising easily, the male organ contains certain cells that tend to attract viruses even without the bruising of the foreskin.

Therefore, removal of the foreskin through MC offers enhanced protection against easier access of entry for viruses, because it hardens and darkens the skin that is left, making it more resistant to infections.

However, it must be understood that MC does not offer 100 per cent protection against HIV infection, therefore, males who undergo this process are counselled on how to use other protective interventions such as condoms, to ensure maximum protection against infections.

MC offers protection against acquiring the Human Papiloma Virus, (HPV), which is known to cause penile cancer in males, and even more importantly for Zambia cervical cancer in their female partners.

Dr Phiri said the importance of adhering to the six-week sexual abstinence period and that simple information technology communication methods such as text messages, and calls to the 990 toll-free HIV/AIDS talk-line have been incorporated as a way of reminding men on the importance of adhering to the abstinence period, and as the significance of the returning for review.

The actual process of VMMC starts with registration, followed by counselling and testing for HIV/AIDS.

For those found to be HIV positive are referred to ART clinics and places like the University Teaching Hospital (UTH) for specialised HIV/AIDS treatment assistance.

VMMC mainly deals with men who are HIV/AIDS negative, because the objective for carrying out MC was to reduce the spread of HIV.

The next process is what is referred to as clinical assessment, where the client is checked for physical and medical fitness to undergo MC.

In cases where a client presents with symptoms of STI’s, they are first treated and MC is only provided upon successful completion of treatment.

The VMMC operation, which lasts about 20 to 30 minutes, begins with an injection of a local anaesthetic to make the operation pain-free.

After the operation, the men are advised to take simple pain killers such as panado, if they feel pain when the anesthesia wears out.

The healing process for the outside wound is about five to seven days, but that complete healing takes up to six weeks, a period in which clients are advised to abstain from any sexual intercourse.

The first review is 48 hours after the operation, when the client is required to return to the MC centre for review and removal of bandages.

In Kennedy’s own words, his initial reactions to suggestions of MC were mixed, but after weighing the pros against the cons, he realised that it was one of the most effective ways he could embark upon as an individual to curb the spread of the virus.

The fight against HIV/AIDS is not the responsibility of the person next to you, but every individual effort counts and adds up to collective national, regional and global efforts aimed at reversing and eventually halting the spread of the disease.

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