The Case for Male Circumcision in Kenya and Sri Lanka
The human immunodeficiency virus (HIV) is a lentivirus that causes the acquired immunodeficiency syndrome (AIDS), a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. As of 2016, approximately 36.7 million people are living with HIV globally. Of these, approximately 30.8 million are men and 3.9 million are women.
In many parts of the world, including Sub-Saharan Africa, the Caribbean, and South Asia, traditional male circumcision is widely practiced. In Kenya, for example, traditional circumcision is carried out by elders of the village as part of a boy’s coming-of-age ceremony. In Sri Lanka, traditional circumcision is less common but still practiced by some ethnic groups, such as the Muslims.
There is growing evidence that male circumcision can reduce the risk of acquiring HIV. In 2005, three randomized controlled trials (RCTs) conducted in South Africa, Uganda, and Kenya found that circumcised men were significantly less likely to acquire HIV than uncircumcised men. Since then, several other observational studies have confirmed these findings.
The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommend that male circumcision be included as an additional strategy for preventing HIV acquisition in settings with heterosexual epidemics, high prevalence of HIV, and low levels of male circumcision.
2. The case for male circumcision in Kenya
Kenya has one of the highest rates of HIV infection in sub-Saharan Africa, with an estimated 1.6 million people living with the virus in 2015. The vast majority of new infections occur through heterosexual contact (93%). In 2009, the Kenyan government launched the National Male Circumcision Programme (NMCP) with the goal of circumcising 80% of all eligible boys and men by 2013.
Despite significant progress made in recent years – over 1 million Kenyan men have been circumcised since 2009 – male circumcision coverage remains low at 36% (as of 2015). One reason for this low coverage is that many men do not see themselves as being at risk of HIV infection and therefore do not see the need for circumcision. Other reasons include cultural beliefs and practices – some communities believe that circumcision reduces sexual pleasure – and lack of access to services – most circumcisions are performed in private clinics which charge fees that many Kenyans cannot afford.
The Kenyan government has taken steps to address some of these barriers by making circumcision services free of charge at public health facilities, training Traditional circumcisers to perform safe operations, and launching behavior change communication campaigns to increase demand for circumcision services among men and boys.
3. The case for male circumcision in Sri Lanka
Sri Lanka has one of the lowest rates of HIV infection in Asia Pacific region, with an estimated 12 thousand people living with the virus in 2015. The vast majority of new infections occur through heterosexual contact (85%). In 2010, only 0.1% of Sri Lankan adults were living with HIV; by 2015, this had risen to 0.3%.
Even though Sri Lanka has a very low prevalence of HIV compared to other countries in the region, there is still a need for prevention measures as the number of new infections is on the rise. One prevention measure that has been shown to be effective in reducing the risk of HIV acquisition is male circumcision.
The Sri Lankan government does not have a national male circumcision programme. However, some religious and cultural groups do promote and perform traditional circumcisions. For example, the Muslim community in Sri Lanka regularly circumcises boys as part of their religious beliefs and practices.
Male circumcision is a proven method for reducing the risk of acquiring HIV. In countries with high rates of HIV infection, such as Kenya, and in countries where the prevalence of HIV is low but rising, such as Sri Lanka, male circumcision should be promoted as a key prevention strategy. National programmes to increase access to safe circumcision services need to be implemented in order to achieve significant reductions in HIV incidence.
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