KAPALA CHISUNKA, Lusaka
IN 2012, Alex Njovu decided to go for voluntary medical male circumcision (VMMC), a public health by the Ministry of Health programme.
There were many reasons that prompted Mr Njovu to get circumcised. Besides opting to undergo the operation as a challenge to himself, he said the massive campaign encouraging men to get circumcised was one of them.
“That time advertisements on male circumcised were everywhere and that is what had me thinking because I learned that it had a lot of benefits,” Mr Njovu said.
He said other benefits that helped him go for circumcision is the aspect of cleanliness that comes with removing the foreskin as well as the fact that it also prevents the transmission of cervical cancer in women.
Mr Njovu said at the time he decided to go for circumcision, he had been married for 10 years. He also encouraged his teenage son to get circumcised with him.
He thinks there might be some other fringe benefits too.
“In terms of intimacy, I last longer in bed and my wife has appreciated that aspect about our love life,” he said with a smile.
Mr Njovu encourages other men and boys to undergo circumcision. He said women have a role to play in encouraging their partners to undergo circumcision because they, too, are beneficiaries.
However, Mr Njovu was quick to add that they need to go to health centres instead of being attended to by untrained people as anything can go wrong that can affect proper functioning of the male organ.
“I am aware that this operation is free in all public health institutions and so I would like to encourage all men and women to seek professional help instead of taking their husbands and spouses to backyard clinics,” he said.
But getting circumcised is not a magic bullet against HIV infection, he warns men.
Mr Njovu is one of the more than two million men and boys who have been circumcised through the VMMC programme, which was officially launched in Zambia in 2009.
According to VMMC programme officer Royd Kamboyi, the programme is also an HIV and AIDS prevention intervention programme which the ministry is implementing to encourage men and boys to go for circumcision.
Mr Kamboyi said as compared to the year the programme started running in 2009 when only 500 men were circumcised, the overwhelming response that has been received over the years is an indication of how much people are appreciating it.
“The response has been overwhelming. In a single month, we are now circumcising over 100,000 males during campaigns in Zambia. Since the programme started in 2009, more than two million men have so far been circumcised,” he said.
Mr Kamboyi said male circumcision is the complete removal of foreskin from a male organ and it is performed by qualified medical personnel. He said personnel engaged in conducting the operation go through extensive training on surgical skills on male circumcision.
“It is performed in health institutions. Rules of surgery apply to circumcision and these are that the operation must be conducted in a theatre, in a clean environment and that all tools are sterilised to ensure that all germs that can cause infection are eliminated,” he said.
Mr Kamboyi said the Ministry of Health is running two programmes on circumcision: early infant male circumcision and adolescent and adult circumcision.
“The age bracket for early infant circumcision starts on the day the baby is born to two months or within 60 days after birth. Then the other bracket is from one year and above. It does not matter the age limit, even a 70-year-old man can get circumcised,” he said.
Among the many benefits of VMMC is that it is an effective HIV prevention strategy that has been proven to reduce the risk of contracting the virus by 60 percent, as well as reducing the risks of contracting other sexually transmitted infections.
“VMMC also helps to reduce the risk of cervical cancer for female sex partners, cancer of the penis as well as urinary tract infections in children. It also prevents phimosis and paraphimosis,” he said.
Phimosis is a condition where the foreskin is too tight to be pulled back over the head of the penis.
He said the ministry is running a campaign on VMMC which was launched on August 1 to September 30 which is also aimed at encouraging men to get circumcised. More than 150,000 men have been targeted for the campaign.
He said VMMC is free at all health institutions in all the 10 provinces.
“When one is circumcised, there is a permanent protection of up to 60 per cent; the other 40 per cent is for him to use other prevention interventions, he said.
Mr Kamboyi said there are some major differences between traditional circumcision and medical circumcision although both operations target the foreskin.
“The difference is in the way surgery is conducted. During traditional circumcision, a knife or scissors may be used but only sterilised medical tools are used during VMMC and we ensure that all blooding points are carefully sealed. We also ensure the area is clean with antiseptics so that there are no infections,” he said.
Mr Kamboyi was quick to state that the ministry has discussed with traditional leaders that the surgical part be handled by professionals while teachings are left to traditionalists.
“We help conduct the operation during some traditional circumcision and leave the traditional teachings aspect to the traditional leaders. We are concerned about the healing process of the wound and environment it is conducted in,” he said.
He said after VMMC, there are also three follow-up visits to give the men an opportunity to interact with the health personnel to discuss and open up about other reproductive health issues.
“When they are conducting the traditional male circumcision, prevention of severe bleeding is difficult and there is a risk of infection as well. And in some cases, they may use the same instruments which could increase the risk of transmission of diseases,” he said.
With regards to misconceptions about reduction of sensation during sexual intercourse after circumcision, Mr Kamboyi said it has not been scientifically proven.
He, however, acknowledged that clients are different and the effect of the operation may affect them differently.
“The science is that the foreskin is quite sensitive and when it is removed what remains is the top of the penis which is a little bit hard, that hardness is what prevents HIV infection. In terms of sex, it all starts in the mind; it has nothing to do with circumcision,” he said.
He said the Ministry of Health through VMMC programme has also incorporated other religions that conduct circumcision like the Muslims.
Islamic Supreme Council of Zambia (ISCZ) president Suzyo Zimba said although it is a religious requirement for male children to be circumcised, he is of the view that the operation be conducted at a health facility.
He said in the past, it was expected that the male child be circumcised in groups but that with the coming of VMMC, parents are also being encouraged to take advantage of the free services offered at government health facilities to circumcise their children.
“Times have changed. I was circumcised in the bush but I took my two sons to the University Teaching Hospitals because it is safer and reduces risks of infection. We have been encouraging parents to take their children to the health facilities as opposed to doing it in isolation,” he said.
He said taking children to UTH does not compromise the Islamic teachings. However, Mr Zimba said circumcision should not only be associated with Islam because there are a lot of people and cultures that practise it for different reasons, including religious beliefs.
He said circumcision is a command in both the Quran and the Bible and that it is not acceptable for a man to meet his creator without being circumcised.
“You cannot stand before your God with your unclean foreskin. Circumcision signifies strong beliefs in our religious teaching. Yes, those people who circumcise traditionally are trained by government agencies and have documents to support it,” he said.
Mr Zimba said he is against continued practices that involve circumcising male children away from health institutions.
“I am totally against conducting circumcision in an environment that puts the lives and health of the children at risk of infections,” he said.