Uganda: Male circumcision against HIV

As he prepares to circumcise 25-year-old Paul Katende, the doctor unpacks his surgical instruments one by one: scissors, syringes, blades and other tools. They were making the young man visibly nervous: "I am already scared of going into that room, eh!" he said.

He thought he would take two months to heal. "That is too long for someone like me. I have to move, I have to walk, I have to do everything," he told DW. Doctors say recovery takes between ten days and two weeks. Anyway, Katende said he wanted to play it safe. "The good thing is, the infections I have been getting will all reduce, as will the risk of getting HIV, because it is what the government says, haven't you heard?"

Lessening the risk

Voluntary medical male circumcision was launched in Uganda in 2010 as a preventive measure to reduce new HIV infections. Studies show that it lessens men's chances of getting HIV by 60 percent. According to Uganda's Aids Commission, eight out of 100 women and six out of 100 Ugandan men are HIV positive.

"The number of  men getting circumcised kept growing and by 2013 we were circumcising more than 800,000 people. But after 2014 we saw a sharp drop. In 2016 we went up slightly to about 400,000. So you can see, we picked up and dropped again and we are trying to pick up again," Dan Byamukama, who heads the HIV Prevention at the Uganda's Aids Commission, told DW. The drop was mainly due to Ugandans not realizing the importance of the procedure, but also because of a lack of proper equipment.

Too complicated

There was another reason, though. Physician Dan Byamukama said that the health ministry did not realize that the introduction of compulsory double vaccination dosage would also lead to the decline in the voluntary male circumcision."The government started a policy of making sure that before they get circumcised, men must get immunized against tetanus."

That requires an injection, after which one has to wait 28 days before one can be circumcised, Byamikama explained. "The process is cumbersome; men don't have time to come twice to the hospital," he said. 

Too busy

Before the actual 30-minute procedure, men are screened for AIDS and other sexually transmitted diseases. During the ambulant surgery, local anesthesia keeps the pain in check. The patient can go home afterwards.

80 per cent of boys and men aged between ten and 24 do not have any qualms about undergoing the procedure. But those older than 25 years are reluctant to undergo this minor surgery. Sentamu Robert, who drives a bicycle taxi known as a boda boda in Uganda, said that the only way he was going to a hospital was if he were unwell. "At my age I don't think I will go for that circumcision. First of all I am a busy man and it's difficult to go to hospital when you are not sick. I even hear that I have to be immunized before getting circumcised," he told DW.