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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
KENYA: Challenge for AIDS Fighters: Circumcising Africans
Mark Schoofs
September 12, 2007
Wall Street Journal (09.07.07) - Wednesday, September 12, 2007

Male circumcision can reduce female-to-male HIV infection risk by up to 60 percent, studies show, but several obstacles remain to implementing the procedure safely. With modern medical equipment and approaches, the complication rate of male circumcision is generally under 2 percent.

In Kenya, more than 80 percent of men are circumcised. In a 2006 study of traditional circumcision in Kenya involving more than 1,000 boys and teens, 35 percent suffered complications such as excessive bleeding, infection and pain when urinating. Ritual circumcisions may involve ceremonial knives, no anesthetic, antiseptic or dressing. And while the procedure may be offered more cheaply by culturally revered traditional practitioners, they can lack even the most rudimentary training.

However, problems can persist even in medical settings. Some medical personnel lack adequate tools, such as sharp scissors, or methods of sterilization. The shortage of doctors leaves a vacuum for the influx of unofficial freelance operators. And poorly educated patients may not be able to distinguish between doctors and nurses and dangerous quacks. In medical settings, including private clinics, 17 percent of patients circumcised in 2004 in Bungoma District, Kenya, experienced adverse side effects.

Dr. Cherutich of Kenya's health ministry hopes his country will offer circumcision free, to prevent unsafe surgeries. There are fewer than 6,000 doctors for 36 million Kenyans, he noted, so the circumcision task force will consider how to train nurses to perform the surgery. However, as most nurses are women, and there are prejudices against female circumcisers, cultural objections may also drive some males to unsafe or no circumcision.