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)