Uganda Men Prefer China Style Male Circumcision

By Esther Nakkazi

Andrew Sekitto, 35 years, was hesitant to be part of the research on voluntary medical male circumcision (VMMC) that was held in Rakai, Uganda, nine years ago. It was a landmark research in 2007 that proved that adult male circumcision reduced the risk of acquiring HIV infection by 60 percent. Sekitto just feared the ‘cut’.

Now, after conversations with friends, who were part of the China invented Shang ring research, still in Rakai, he has had medical male circumcision. He says his wife, Sarah Nambi, and him too, appreciate this procedure because his penis looks neat with no sutures, there was very little bleeding and pain, plus it all healed fast, only a week.

Like the growing trade between Africa and China, the ‘Chinese cut’, is preferred to the conventional method of VMMC by many Ugandan men. It is, thus, envisaged that the Shang ring might accelerate male circumcision programs in Africa.

Steven Mugamba, a researcher with the Rakai Health Sciences, which, has been part of both studies said, while they required 250 men to enroll for the just ended study on acceptability and safety of the Shang ring, the number of those who enrolled, more than doubled, to 520.

“We have done research for both methods in Rakai. Men say they prefer this method, there is high acceptability,” said Mugamba. The survey site for the Shang ring in Uganda is the third, after similar studies were done in South Africa and Zimbabwe.

A counter study was not done in tandem, but safety and acceptability of the ring by adult men was compared to the already collected data in 2007 that proved the benefit of female to male HIV transmission was reduced by 60 percent.

The Rakai study, now endorses, further and proves that VMMC if done safely, is affordable and has minimal side effects or pain, it is easily acceptable. But also more men, in Uganda, accepting VMMC using the Shang ring could improve progress towards the target of having 4.2 million males circumcised in the country by 2015.

Only 25 percent of the required target of men to be circumcised in Uganda has been met, which questions the country’s ability to use scientifically proven medical interventions to reverse the rising prevalence and infection rates.

“This country’s national safe male circumcision plan lacks a budget, annual targets or concrete plans for scale-up. In fact, there is persistent contradictions among officials about whether even circumcision has a role in the response to HIV in Uganda,” said Alice Kayongo, an HIV advocate from Alliance Uganda.    

UNAIDS and the World Health Organization (WHO) issued recommendations for VMMC, for countries with high prevalence rates, hoping that at least 80 percent of males aged 15-49 years in 14 priority countries including Uganda, Kenya and Tanzania would be circumcised.

According to mathematical modeling based on a timeline, if 80 percent coverage where achieved by 2015, more than 20 percent of new HIV infections would be averted by 2025, with an estimated $16.6 billion saved in future medical costs in these countries. 

However, even if Uganda’s HIV prevalence has risen from 6.4 to 7.3 percent, its progress towards bringing this prevention intervention to scale is still so slow. But the Shang ring could be helpful and this is why.  

One bright sunny morning, when Sekitto decided to go for the Shang ring VMMC after being convinced by a friend, he was amazed. The procedure that took about 5-10 minutes with no general anesthesia but only for the part to be operated part was not painful at all.

Basically, his penis was marked to gauge its size that would fit the forceps (plastic rings) which were placed on it, the sides of the skin were cut, to give way for applying the outer ring. He then walked home to his wife, with the ring on the penis, only to return after a week to have it removed. There were no sutures, little bleeding and no pain.     

Experts believe that once the PrePex, another non-surgical procedure, which is the next research that the Rakai Health Services will embark on is introduced even more men will opt for VMMC and the targets are met.

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