By: Rosemary Stephen, Elements: Environmental Health Intelligence
Male Circumcision to Fight Spread of HIV / AIDS
Malawi is a land-locked country located in southern Africa. It is situated east of Zambia and shares borders with Mozambique, Tanzania and Zambia. It is a small country; the total area of Malawi is slightly less than that of the state of Pennsylvania. The country has a population of circa 15 million people, 19% of whom live in urban areas. Malawi faces many public and environmental health challenges including foodborne, waterborne, vectorborne and zoonotic diseases such as rabies, however, in addition, Malawi has a prevalence of HIV/AIDS. HIV/AIDS is a major problem with as many as 11.9% of the adult population affected by the virus [1]. An estimated 68,000 people died from this disease in 2007 alone.
A pilot program focusing on male circumcision will soon be starting in Malawi “as one way of complementing efforts in the HIV and Aids fight” and “scaling down the infection rate” [2]. In the on-line article entitled Malawi clinic BLM (Banja La Mtsogolo) to embark on male circumcision to fight HIV/AIDS [3], Cephas Zaoneka from the BLM’s Regional Outreach Officer explains that investigation into the prevalence of HIV/AIDS in uncircumcised males motivated this pilot project. I was able to track down the UN AIDS / WHO report entitled New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications published in 2007 [4] which served as the basis for the above mentioned trial. The WHO web site gives a very thorough explanation of the agency’s findings as well as outlining why male circumcision is recommended.
I found this article very interesting and I encourage everyone to read it, including all pages of the Comment section (the comments are written in English or in one of the country’s official languages). The Comments are interesting because they give an excellent window into how the local population perceives this decision. A priest even wrote a comment about it !
Unknown Virus
On a completely different note, but again in Malawi, we learn of a recent number of deaths from an unknown virus. So far, 15 individuals have died and 100 people have been affected in the Neno district of the country. The neighboring country of Mozambique has also been affected with 40 people contracting the virus resulting in 9 deaths. At the request of the Malawi Government, samples have been taken by 5 US specialists and sent to the Center for Disease Control (CDC) [5].
This web site did not give many details of the signs and symptoms of this virus. I did, however, manage to find more details thanks to a posted thread from FluTrackers.Com. It appears that this disease began in May this year [6] and the people who commented on this outbreak suspect water as the cause of the illness [7]. A ProMED-mail post dated July 11 2009 mentions a possible link between the virus and the living condition of the affected villages. In some areas of the Nino district, advisors have enlisted the help of traditional leaders to tell their people to avoid sleeping with animals. Blood samples taken from the victims have yielded negative results for meningitis, leptospirosis or other specific diseases [8]. I will be following this story and I will post information as it becomes available.
References for: Male Circumcision to Fight Spread of HIV / AIDS
[1] Malawi, The World Factbook (2009) Central Intelligence Agency. (On-line) Avialable: https://www.cia.gov/library/publications/the-world-factbook/geos/mi.html. Cited 2009 Jul 29.
[2] Mana, Malawi clinic BLM to embark on male circumcision to fight HIV/AIDS (2009) Nyasa Times. (On-line) Available:
http://www.nyasatimes.com/health/malawi-clinic-blm-to-embark-on-male-circumcision-to-fight-hivaids.html. Cited 2009 Jul 29.
[3] Mana, Malawi clinic BLM to embark on male circumcision to fight HIV/AIDS (2009) Nyasa Times. (On-line) Available:
http://www.nyasatimes.com/health/malawi-clinic-blm-to-embark-on-male-circumcision-to-fight-hivaids.html. Cited 2009 Jul 29.
[4] New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications UN Aids (2007) World Health Organization (On-line) Available: http://data.unaids.org/pub/Report/2007/mc_recommendations_en.pdf. Cited 2009 Jul 29.
References for: Unknown Virus
[5] US medical experts in Malawi to investigate bizarre virus (2009) Nyasa Times. (On-line) Available: http://www.nyasatimes.com/health/us-medical-experts-in-malawi-to-investigate-bizarre-virus.html. Cited 2009 Jul 28.
[6] Outbreak of meningitis/encephalitis in Mozambique (and Malawi) (2009) FluTracker.com (On-line) Available: http://www.flutrackers.com/forum/showthread.php?p=273372. Cited 2009 Jul 29.
[7] US medical experts in Malawi to investigate bizarre virus (2009) Nyasa Times. (On-line) Available: http://www.nyasatimes.com/health/us-medical-experts-in-malawi-to-investigate-bizarre-virus.html. Cited 2009 Jul 28.
[8] Outbreak of meningitis/encephalitis in Mozambique (and Malawi) (2009) FluTracker.com (On-line) Available: http://www.flutrackers.com/forum/showthread.php?p=273372. Cited 2009 Jul 29.
Map (cited 2009 July 30) available at Google maps, : http://maps.google.ca/maps?q=google%20maps&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl.
{ 2 comments… read them below or add one }
Thanks for this article, but the first one raised some question; I think it’s a scary thing. Why would you implement something that only works for a bit? Wouldn’t this make people think they can have unprotected sex now since they are circumcised? It’s especially the one-way protection that scares me; a guy who feels safe because the scissors were used on him can now go around and spread some more infections…
And I’m wondering what the time is before a circumcision becomes effective. I can see how this will be effective within the first week after having the procedure done — ouch!
— but since it’s believed that it can help preventing from getting infected due to the forming of calluses, I guess it might take quite some time before this will make a difference, right? Are there any numbers known for that?
Hello Stefan,
Thank you for your questions –
Male circumcision is considered a preventive measure by the World Health Organization and UNAIDS, one element in a whole prevention package. Studies on male circumcision have shown that it is an effective way to reduce the transmission of HIV during heterosexual intercourse by 50% to 60%. What these agencies are targeting is mostly HIV transmission from women to men. They are also in the process of evaluating if circumcision is an effective method of reducing HIV transmission from men to women.
Before circumcision is carried out, men are provided with culturally sensitive information and counseling. This includes detailed information about the procedure, its uses and limitations, and about post-operative care. Men are carefully reminded that they are not protected from risky sexual behavior and that wearing a condom is the best way to prevent the transmission of HIV and other sexually transmitted diseases. They even encourage men to insist their partners wear a female condom. Once the counseling is done, a consent form is filled in and signed.
It is recommended to wait one week after the procedure before going back to work or resuming physical activities and six weeks before resuming love-making. After six weeks men are fully healed.