Integrate Partner-supported Voluntary Safe Male Circumcision into the fight against HIV and AIDS
By Onen David Ongwech, Programme Manager - Gender & Sexuality (Published 23rd May 2016)
Several decades have passed and scientists still continue to seek durable and workable solutions to HIV and AIDS. As the quest for the cure is still in limbo, several approaches have seen light of the day, including the famous ABC (Abstinence, Be Faithful, use Condoms) strategy.
The ABC approach continues to encounter resistance; Condom use is contested among some faith-based sects while Abstinence and Being Faithful are impractical for some people. In the search for alternative feasible and faith friendly options, advocacy for Safe Male Circumcision (SMC) became pertinent.
Recent studies in African men have demonstrated that SMC reduces the risk of HIV acquisition by approximately 60%. SMC has also been shown to reduce incidence of genital ulcers and Human Papilloma Virus (HPV). This figure has encouraged medical centres, civil society and government agencies to mobilize more resources to support SMC while giving inadequate consideration to involvement of partners. (Johnson, K. E., & Quinn, T. C, 2008. Update on Male Circumcision: Prevention Success and Challenges Ahead).
Uganda is known for taking fast and steady strides in policy formulation and enactment of legislation on key issues of concern. In January 2010 the Ministry of Health endorsed a recommendation by the World Health Organization (WHO) and UNAIDS that SMC be considered as part of a comprehensive HIV prevention package (Technical Guidance Note for Global Fund HIV Proposals, UNAIDS/WHO 2011).
Subsequently, a Safe Male Circumcision Policy was developed in 2010. Envisioning a healthy and productive population free from HIV infection, the SMC Policy remains one of the key documents in the promotion of SMC and the fight against HIV and AIDS.
Since then numerous billboards have been flooded with SMC messages as medical camps and health centres continue to provide SMC related services for free. However, the increasing advocacy and media outburst to fight HIV and AIDS through Safe Male Circumcision is doing very little to involve women in the campaign.
Women are instead being encouraged to shame uncircumcised men. You may have seen billboard messages such as “You mean you’re not CIRCUMCISED! Stand Proud, Get Circumcised”, “I am proud I have a circumcised husband because we have less chances of getting HIV”, “Forget size, you mean you are not CIRCUMCISED!” (Supply the Main Challenge in Male Circumcision, IRIN News KAMPALA, 30 May 2012).
Such messages may incite disrespect and ridicule and promote stigma and misandry towards uncircumcised men. They project uncircumcised men as transmitters of HIV even when some men regard circumcision as a permanent act of mutilation with negative physical and psychological consequences. They present circumcision as the solution, even when a circumcised man should be advised to use condoms to reduce the risk of contracting HIV and AIDS.
Men need to involve their partners before they finally sign waivers and lie down on the SMC bed. Where applicable, partners need to be encouraged to move together to health centers and hospitals where SMC is conducted for information and counseling. Partners’ involvement in the decision to circumcise helps to build relationships and strengthen mutual understanding in families. It can help to reduce creepy doubts and feelings of cheating and unfaithfulness.
The Uganda Male Circumcision Policy 2010 recommends counseling by trained personnel as an integral element of the male circumcision intervention. However, the policy does not provide for involvement of partners. It ignores sex and sexuality as a key component of marital lives and the fact that excluding partners from decisions on circumcision can be a potential cause of tensions.
Perhaps we all know of women beaten and thrown out of their matrimonial houses for having taken injections for birth control without their husbands’ consent, or for having undergone Female Genital Mutilation. Similarly, we have seen media reports about women discouraging their husbands from circumcision, as well as protests from women whose husbands were circumcised without their consent. Indeed, reports have shown men being pestered into sex by their partners barely hours after SMS surgery.
Pre and post-surgery couple counseling could bridge these gaps. Partners need to be mobilized for health education on SMC to learn basic facts and be able to support their husbands before, during and after surgery (Bringing Women on Board in Safe Male Circumcision in Uganda, A USAID ASSIST Blog Post - July 5, 2013 accessed from http://bit.ly/1TnmgiN).
The potential consequences of SMC, especially those associated with intimate partner violence, can be reduced when partner-supported SMC is integrated into practices. Partners can benefit more if they walk together to centres where SMC is being conducted alongside other services such as cervical and breast cancer screening for women and other Sexually Transmitted Infection screening for both men and women.
It is vital that hospitals, civil society, government and other organisations providing services related to circumcision fully integrate gender into their programming on voluntary safe medical male circumcision. Men need to be encouraged to involve their partners in the discussion, preparation and consent for circumcision; just as men are currently involved in family planning, maternal health and child care and upbringing.