Uganda Plans To Introduce No-Cost, Countrywide Male Circumcision Program To Prevent Spread of HIV, Health Official Says

Uganda's Ministry of Health plans to introduce a no-cost, countrywide male circumcision program in an effort to prevent the spread of HIV, Sam Zaramba, Uganda's director-general of health services, said recently, Uganda's New Vision reports (Bainemigisha, New Vision, 12/10).

According to final data from two NIH-funded studies -- conducted in Uganda and Kenya and published in the Feb. 23 issue of the journal Lancet -- routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65%. The results of the Uganda and Kenya studies mirrored similar results of a study conducted in South Africa in 2005. In response to the findings, the World Health Organization and UNAIDS in March recommended the procedure as a way to help reduce transmission of the virus through heterosexual sex (Kaiser Daily HIV/AIDS Report, 9/20).

According to Zaramba, health care leaders are consulting HIV/AIDS and service delivery stakeholders to determine "how best" to implement the program. Stakeholders on Sunday met in Kampala, Uganda, to discuss policy and ethical implications associated with the program and to build a consensus before launching it. According to Alex Opio, assistant commissioner of Uganda's National Disease Control, the program "must be acceptable to people of all faiths, tribes, communities and their leaders" to be effective. Opio added that the program will be part of Uganda's ABC prevention strategy -- which stands for abstinence, be faithful and use condoms.

Attendees at the meeting also discussed a planned survey that aims to establish how prepared health facilities and the public are for the program. The survey -- which will be conducted in several districts, including Gulu, Kabale, Kampala, Kumi and Mbale -- also will advise policymakers on how to streamline requirements of the program; how to train health workers; how to allocate resources for the program without negatively affecting existing health programs; and how to best monitor the procedures. Participants at the meeting also asked for input from Kenya and Rwanda, where similar programs are in place.

The program initially will be implemented in areas with low circumcision rates and high HIV prevalence, participants said. The participants added that HIV testing prior to circumcision should not be mandatory because it could discourage some people from undergoing the procedure, the New Vision reports (New Vision, 12/10).