UGANDA: Lack of resources, political will slows male circumcision progress

Photo: Edward Echwalu/IRIN

Under the knife

KAMPALA, 31 October 2011 (PlusNews) -  Ugandan men have been seeking medical male circumcision in droves since the governmentlaunched a national policy in 2010, but the health system is not equipped to handle the caseload, slowing down the potential HIV prevention benefits of the campaign. 

"Communities have shown a lot of interest in male circumcision, but we are not meeting the demand; our target is 80 percent of uncircumcised men but we have only met about 5 percent of that," said Zainab Akol, manager of the Ministry of Health's AIDS Control Programme. 

"We have insufficient human resources, infrastructure, kits and of course money," she added. 

Just 56 percent of the country's health worker positions are filled, and many are not trained in male circumcision. 

An estimated 25 percent of Ugandan men are circumcised, but studies have shown the population to be open to the idea of male circumcision for both adults and infants. 

The US President's Emergency Plan for AIDS Relief, PEPFAR, is supporting much of Uganda's male circumcision activities and since May, has conducted several mobile male circumcision clinics, recording high volumes in all the areas it has visited so far. 

At the Rakai Health Sciences Programme (RHSP) in central Uganda, one of the largest male circumcision providers in the country, there is a steady stream of men seeking the services and health workers seeking training, but even this relatively well-funded programme has difficulty meeting the demand for its services. 

SLIDESHOW: Male Circumcision in Uganda

Photo: Edward Echwalu/IRIN

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"Last financial year, which ended on 31st March, 2011, we managed to train about 300 health workers, but this was way below the number of applications we received," Rajab Kakaire, a doctor with the RHSP, told IRIN/PlusNews. 

Costly sluggishness 
According to a recent report by the UN World Health Organization (WHO) on the scale-up of male circumcision delivery in eastern and southern Africa, just 9,052 circumcisions were carried out in Uganda in 2010, against more than four million men who would need to be circumcised for the country to reach its 80 percent target.

WHO estimates that if Uganda achieved the 80 percent target within five years, the country could potentially avert close to 340,000 new HIV infections. 

A study released in July 2011 found that a male circumcision programme in the township of Orange Farm in South Africa - one of the sites of the original randomized controlled study that showed the effectiveness of male circumcision in HIV prevention - resulted in a 55 percent reduction in HIV prevalence and a 76 percent reduction in new HIV infections in circumcised men. 

Political will
The WHO report found that Uganda's male circumcision lacked leadership, with no prominent national champion. In fact, HIV activists have blamed the lack of momentum in the national programme on President Yoweri Museveni's continued lack of enthusiasm for male circumcision. 

By contrast, Kenya's Prime Minister, Raila Odinga - who comes from the non-circumcising Luo community - has embraced the country's male circumcision campaign, which has been a runaway success; Museveni was earlier this year quoted by local media as questioning the scientific evidence behind medical male circumcision. 

"Now it is circumcision which is not... being supported but even sabotaged by our political elite who openly discourage people from embracing the practice, saying it will not protect them," Stephen Waititi, a senior medical officer at Mildmay Uganda, an HIV-focused NGO, said in an editorial in a local paper in July. 

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