In-depth: At the Cutting edge - male circumcision and HIV
WEST AFRICA: Fears circumcision could weaken prevention messages
Photo: Claire Soares/IRIN
Activists are concerned that prevention gains could be eroded
Dakar, 18 July 2007 (IRIN In-Depth) - In Burkina Faso and Senegal, where male circumcision is widely practiced, AIDS prevention workers have received the news that circumcision can reduce a man's chances of contracting HIV by up to 60 percent with extreme caution.
As in most of West Africa, the vast majority of men in both countries are circumcised: an estimated 90 percent in
Burkina Faso and 95 percent in
Senegal, where the HIV prevalence rate is 0.7 percent, one of the lowest on the continent.
However, AIDS activists in this part of Africa are worried that the recent findings, based on a clinical trial each in South Africa, Uganda and Kenya, could encourage complacency.
Promoting - or not promoting - male circumcision "is not a concern for us," an official at Burkina Faso's National AIDS Council told IRIN/PlusNews. "It is not included in any of our guidelines, since people already do it."
A study published this year by Dr Cheikh Ibrahima Niang, a researcher at the University of Dakar, Senegal, showed that a number of ethnic groups surveyed in Senegal and Guinea Bissau considered circumcision an essential rite of passage in a man's life, "equivalent to the loss of virginity of a woman".
The authors went on to explain, "The foreskin is associated with ugliness and lack of pride ... It is considered dirty, a source of bad smells and disease, or even of evil ... [in some communities]. One of the main reasons why a woman might feel sexual repulsion towards a man is the absence of circumcision."
It is not a new concept: "The idea that circumcision protects against sexually transmitted infections already existed in the villages", according to studies carried out in the 1980s, Niang told IRIN/Plus News.
The World Health Organisation and UNAIDS have published guidelines recommending that male circumcision be recognised as an important HIV prevention strategy, but have been careful to emphasise that it be viewed "as part of a comprehensive HIV prevention package", and not as a substitute for existing methods.
Nevertheless, AIDS prevention workers in Senegal and Burkina Faso are concerned about how this information will be interpreted by people in their countries, most of whom are illiterate.
"This is a scientific approach which poses problems, as they are claiming something, even though it only reduces the risk by 60 percent," said Innocent Sewoa Laïson, senior programme manager of the African Council of AIDS Service Organisations (Africaso) based in Senegal. "There is a risk that this will jeopardise prevention efforts of the last 20 years."
Martine Somda, president of REV+, the acronym in French of an association for people living with HIV in Bobodioulasso, Burkina Faso's second largest city, agreed. "This is recent information. We do not intend to disseminate it since it could confuse people and cancel out what we have achieved. This must not work against the use of condoms."
Other AIDS activists took the view that the decision to remove, or not remove, the foreskin should be left to the individual.
"It is a traditional practice which can reduce the transmission of HIV, which each person must interpret in the way that they are able; this is how the message can be given," suggested Mamadou Sawadogo, coordinator of REDIPIV-BF, the French acronym of a national network of organisations for people infected and affected by HIV/AIDS in Burkina Faso.
Approximately two percent of Burkina Faso's 13.2 million people are HIV-infected, with higher rates in urban areas: 5.4 percent in the capital, Ouagadougou, and 3.8 percent in Bobodioulasso.
Over the last two decades, non-governmental organisations have made important strides in educating people about HIV and how to avoid contracting it, with increasing support from the authorities.
HIV prevalence has stayed stable for the last few years. Sales of subsidised condoms by PROMACO, an HIV prevention programme run by the non-profit social marketing organisation, Population Services International, in collaboration with Burkina Faso's National AIDS Programme, have risen from 500,000 in 1991 to 20 million in 2005.
With AIDS information widely available, at least in urban areas, ordinary people have also expressed concerns that messages about the protective benefits of male circumcision could "muddy the waters".
"I have known men around me who were infected or have died from AIDS; some were circumcised, some weren't," said Djeneba Kone, who lives in Bobodioulasso.
Cynthia Sawadogo, a sex worker in the same town, said the announcement didn't change anything, and that "whether someone is circumcised or not, I still make my partner wear a condom."
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