By Wanje Sam
A recent report has highlighted that older, uncircumcised men, particularly those who are single or widowed, are significantly contributing to the rise in new HIV infections in Uganda. This group accounts for about 20% of all new cases, following adolescent girls and young women, who contribute to 36% of infections.
The findings are from the Uganda HIV Modes of Transmission HIV Prevention Synthesis 2023 report, which sheds light on the groups most affected by new HIV transmissions. In 2023, an alarming 15,000 young people, aged 15 to 24, were newly infected with HIV, 80% of whom were young women aged 20 to 24.
These findings were presented during a media engagement at Serena Kampala Hotel, aimed at discussing the barriers preventing Uganda from achieving its 2030 target of eradicating HIV as a public health threat. The event, organized by UNAIDS with support from the Netherlands, underscored the media’s vital role in fighting HIV/AIDS.
According to the report, four main population groups accounted for 78% of new infections: adolescent girls and young women, previously married uncircumcised men, previously married women, and female sex workers. The lowest infection rate was recorded among HIV-discordant couples, at just 0.4%.
The Benefits of Safe Male Circumcision (SMC)
Research conducted over a decade ago in Uganda, Kenya, and South Africa showed that safe male circumcision (SMC) can reduce the risk of contracting HIV by up to 60%. Based on this, the World Health Organization, UNAIDS, and Uganda’s Ministry of Health adopted SMC as part of their HIV prevention strategy in 2012.
Dr. Fred Magara from the Makerere University Walter Reed Project emphasized that circumcision significantly lowers the risk of HIV transmission in HIV-negative men and also helps prevent some sexually transmitted infections (STIs). He explained that the foreskin creates a conducive environment for the virus to survive, increasing the chances of transmission. Removing the foreskin helps reduce this risk by exposing the skin, making it more resistant to infections.
Additionally, circumcision reduces the risk of urinary tract infections (UTIs), particularly in young boys during their first year of life, according to Rashid Simuya, a specialist at Kibuku Health Centre IV.
Despite the clear health benefits, the 2023 report shows that the adoption of SMC remains slow in Uganda. Since 2010, six million men between the ages of 15 and 29 have undergone circumcision, with 66% being young men between 15 and 24. However, this is still insufficient to curb new infections given Uganda’s male population of over 22 million.
Trends in Safe Male Circumcision
The 2023 report also highlighted an improvement in SMC coverage, with the number of men circumcised increasing from 489,733 in the 2021/22 financial year to 499,774 in 2022/23. Most of those circumcised were boys and young men aged 15 to 24, comprising 56% of the total.
However, coverage varies greatly across different regions, with the Karamoja sub-region recording a low of 20.6% while Kampala leads with 73.3%. Although there has been progress, Uganda has not met its annual target of circumcising 850,000 men for three consecutive years. Key challenges include raising awareness and encouraging voluntary participation in SMC programs.
Dr. Vincent Bagambe, Acting Director General of the Uganda AIDS Commission, pointed out that some individuals undermine the SMC initiative by suggesting that circumcision does not prevent HIV, citing cases where circumcised Muslim men still contracted the virus. Bagambe urged that SMC must be performed by trained health professionals to minimize complications and advised the public to combine circumcision with other preventive measures like condom use and fidelity.
There are ongoing efforts to target uncircumcised men, including donor-supported health facilities offering free circumcision services across Uganda’s public and private health centers.
Overcoming Barriers to Circumcision
Some men are hesitant to undergo circumcision due to misconceptions about pain or fears of impotence, according to Peter Mulinde, 50. Moses Kintu, 35, added that some men believe that circumcision’s benefits can be achieved through other methods, such as condom use or maintaining good hygiene.
However, Dr. Mbaaga Kigongo, a consultant urologist at URO CARE Hospital in Nansana, clarified that circumcision does not negatively affect sexual performance. In fact, recent studies conducted in Rakai district revealed that circumcised men reported enhanced sexual satisfaction and performance, including delayed ejaculation. Additionally, their spouses expressed greater satisfaction with their partners post-circumcision.
The challenge remains to dispel myths and raise awareness about the health benefits of SMC, especially as Uganda continues its fight against the HIV epidemic.