Ugandans seek circumcision after evidence of reducing HIV contraction rate

Joseph Mugerwa glanced nervously around him in the sterile white corridor. ''I'm fearing this—I think it will be painful,'' he said while waiting in line earlier this week with 13 other equally anxious men who had come to the Rakai Health Sciences building for a delicate but potentially lifesaving operation: circumcision. Men seeking the procedure, which is uncommon in Uganda, are streaming into the Rakai clinic, where research has helped show that circumcision can significantly reduce men's chances of contracting the virus that causes AIDS.

''The requests are just too many given the facilities we have here,'' says Dr. Godfrey Kigozi, who coordinated the circumcision trial in Uganda. The findings of three major trials—in Kenya, South Africa and Uganda—were published in the Lancet in February.

Many of Uganda's local FM radios have picked up the story and have been spreading the news in a country where up to 880,000 people could be living with HIV/AIDS, according to the World Health Organization.

"HIV is a big problem here—I've lost four brothers and three sisters—so even though I'm [afraid], I'll get it [circumcision] done,'' Mugerwa, 37, a shopkeeper in this sleepy town about 155 kilometers (96.32 miles) from the capital, Kampala.

On Wednesday, U.N. health agencies endorsed circumcision as an important intervention in the fight against HIV but stressed that the procedure offers only partial protection against the killer disease and must be used with other measures such as condoms, abstinence. and delaying the start of sexual activity. Studies suggest that 5.7 million new cases of HIV infection and 3 million deaths over 20 years could be prevented by male circumcision in sub-Saharan Africa.

"I want to offer the best protection I can for my children,'' said Ranard Lutaya, a resident of Kalisizo who said he plans to have himself and his two young sons circumcised. But for now the clinic is offering the surgery, free of charge, only to the 2,500 uncircumcised men who belonged to the control group in the trial. Several other clinics in Uganda offer the procedure for about $17.

''We can only handle the study participants first before we can offer surgery to outsiders,'' Kigozi told the Associated Press. He said the clinic is waiting for guidelines from the WHO on how to roll out the procedure for the general public to ensure that doctors are properly trained and that men know they will be at higher risk of contracting HIV if they resume sexual relations before their wound has healed.He also said the clinic hopes to get funding that will allow doctors to perform the surgery free for the public.

Dr. Kim Eva Dickson, a World Health Organization AIDS specialist, stressed that such money must be additional funding that boosts existing programs targeting HIV. Increasing the practice of circumcision is ''an opportunity to strengthen HIV prevention programming—[including] promotion and provision of condoms, recommendation of HIV testing, management of sexually transmitted infections,'' Dickson said. ''Health services are overstretched, but (circumcision) is an intervention with proven efficacy and could have a potentially great impact on the HIV epidemic.''

The other medical facility in the town, the Kalisizo Hospital, does not perform circumcision unless there is an infection or other medical emergency. The hospital is government-run and does not perform elective surgery.

Still, Dr. George Wagumbulizi, medical superintendent at Kalisizo Hospital, said requests have surged. ''So many people now want their children circumcised ,and even the youth have gained interest and come here asking for it,'' he said. Like the Rakai clinic, the hospital doesn't tally the requests.

An estimated 665 million men, or 30% of men in the world, are circumcised, but the rate varies considerably from country to country. The practice is highly unusual in Uganda.

Though men in Rakai appear to have wholeheartedly endorsed circumcision, their motivation may not just be about HIV prevention. Focus groups conducted at the Rakai Health Sciences Program indicate that women are keen to see their husbands undergo the procedure, since they believe it will improve sexual prowess. For children, the perceived advantage is to reduce the risk of being used as human sacrifices by witch doctors. According to local myth, witch doctors won't target infants who have already shed blood.

''It is a simple, cheap procedure that you just do once,'' says Kigozi. ''This makes the intervention very cost-effective, especially when you compare it to the cost of treating the disease. This has the potential to save millions of lives.'' (AP)