KENYA: Struggling to meet demand for male circumcision
Photo: Manoocher Deghati/IRIN  | | A mother comforts her son who has just been circumcised at a Marie Stopes clinic in Nyanza |
KISUMU, 1 July 2009 (PlusNews) - Demand for medical male circumcision has been rising in Kenya's south-western Nyanza Province since it became available as part of a package of HIV prevention services in November 2008.
Although local communities do not traditionally practice male circumcision, intensive sensitization programmes by governmental and non-governmental organizations are boosting acceptability.
"We are ensuring that this public health measure is implemented in a culturally sensitive environment, and that men and their families have the information they need to make informed choices," said Dr Jackson Kioko, Nyanza's director of public health.
So far 20,701 men have been medically circumcised at 124 private and public health facilities across Nyanza, the only province where the programme has been rolled out.
Nyanza has the highest HIV prevalence in Kenya - 15.3 percent, more than double the national average - and a low level of male circumcision.
A national task force will coordinate wider implementation of the procedure, and the National AIDS Control Council has set aside 16.1 million Kenya shillings (US$212,500) to encourage greater acceptance of it.
Dominic Oyier, 30, a member of the Luo community, which does not traditionally circumcise men, feared he would be ridiculed by his friends and relatives if he decided to get circumcised. "Later, when I received the information from community sensitizers, I thought it was a good thing, especially when I was told that it can even benefit my wife by reducing her chances of getting cervical cancer," he told IRIN/PlusNews.
"I decided to go for it ... It is a scary experience but it is worth it and even some of my friends consult me because they also want to try it out."
 There are men who will come to the clinic seeking these services, but the moment you mention that they have to abstain for six weeks...they change their minds |
Challenges
Dr Walter Obiero, a clinical manager at the Nyanza Reproductive Health Society, said the biggest challenges were the shortage of trained health workers, and persuading men to abstain from sex for six weeks following the surgery.
"There are men who will come to the clinic seeking these services, but the moment you mention that they will have to abstain for six weeks, as is required after the circumcision, they ... change their minds," he said.
"Then there is the issue of staff constraints, especially in government facilities. The number of staff already trained to offer circumcision services falls far below the demand, and other health services also need to be attended to by the same health workers."
Most of the 450 government health workers able to offer male circumcision services including counselling, performing the procedure safely and ensuring infection control, have been trained by the Male Circumcision Consortium, which includes Family Health International, the Nyanza Reproductive Health Society, the University of Illinois at Chicago and EngenderHealth, a reproductive health organization.
Less than one percent of male circumcisions have had an adverse reaction. "Any complication that may arise could be mainly due to the client ignoring the advice of health personnel on how to care for themselves immediately after the procedure," said Dr Obiero.
Until more government health workers can be trained, the consortium is providing more than 75 percent of circumcision services, and taking a lead in informing people that male circumcision provides only partial protection against HIV infection, and they should keep using condoms.
Women have been targeted with information about how male circumcision can benefit them by reducing their risk of cervical cancer and improving hygiene to ensure they support the programme.
Models for providing circumcision services through outreach and mobile services are also being explored.
"The outreach services involve sending providers to health facilities that do not have capacity to offer male circumcision on a regular basis, due to lack of space or insufficient health personnel," said Kioko.
The government and its partners have set a target of circumcising 80 percent of all uncircumcised men between the ages of 15 and 49 in Nyanza over the next 10 years, reaching a total of one million men.
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