Integrated Regional Information Networks - January 9, 2012
KIGALI, 9 January 2012 (PlusNews) - This will be a busy year for
Rwanda's health centres as the country attempts to reach its goal
of medically circumcising 50 percent of men by June 2013 as part
of HIV prevention efforts.
"We plan to extend free male circumcision services to all men in
Rwanda - we are targeting two million circumcisions by 2013,"
said Simoni Kanyaruhango, head of the national male circumcision
programme at the Rwanda Bio-Medical Centre. "The programme has,
under the sponsorship of the Global Fund [to fight AIDS,
Tuberculosis and Malaria], extended the necessary kits ... to all
district hospitals, which will in turn offer the service free of
charge to the public."
The free male circumcision programme began in October 2011, and
officials at the Ministry of Health say demand is growing.
"Here we carry out circumcisions every weekend but we are looking
at including the working days as the demand is increasing by the
day," said Christian Ntizimira, director of Kibagabaga Hospital
in the capital, Kigali.
A large randomized controlled trial in Kenya, South Africa and
Uganda found that medical male circumcision can reduce a man's
risk of contracting HIV through vaginal intercourse by almost 60
In order to reach 80 percent coverage - a target set by UNAIDS
and the World Health Organization (WHO) under a new plan to
accelerate medical male circumcision in eastern and southern
Africa - Rwanda would need to circumcise 1,746,052 men; at
present, some 15 percent are circumcised.
However, with a severe shortage of highly trained medical staff -
according to WHO, Rwanda has just two doctors per 100,000
population - the goal is unlikely to be met unless lower cadre
health workers are involved in the campaign.
At present, the programme is using circumcision surgery, the only
The government is hoping for WHO approval of a device known as
the "PrePex system", which delivers "bloodless" male circumcision
and would reduce the need for a sterile environment, anaesthetic
and highly trained medical personnel. The PrePex system works
through a special elastic mechanism that fits closely around an
inner ring, trapping the foreskin, which dries up and is removed
after a week.
"This device has been clinically studied and found effective. We
are only awaiting approval from the World Health Organization
Technical Advisory Group on technical innovations in male
circumcision," said Vincent Mutabazi, lead investigator in the
PrePex Clinical study.
"With WHO approval of the device, we could perform male
circumcisions anywhere, any time or even run mobile clinics out
to remote communities rather than have men travel long distances
for the circumcisions," said Agnes Binagwaho, the Rwandan
Minister of Health.
Messages on male circumcision have been widely broadcast using
print and electronic media, and health centres are also being
used to promote the programme.
However, many in the target population remain unaware or afraid
of the procedure. "I know about it of course and I appreciate its
importance, but what would happen if I don't heal properly or
even heal at all?" asked James Nkuusi, a restaurant owner in
Remera, a Kigali suburb. "Besides, my wives are used to me the
way I am now - my size, you know. If I got circumcised it would
be difficult for me to satisfy them I guess, and I would never
let that happen."
Experts say male circumcision does not affect penis size.
Rwanda Bio-Medical Centre's Kanyaruhango said the government had
made significant progress in demystifying the procedure. It is
also being careful to emphasize that male circumcision must work
in conjunction with other HIV prevention methods to be
"Male circumcision should only be one element of a comprehensive
HIV prevention package, which should include the promotion of
condom use, the provision of HIV counselling and testing services
and treatment of sexually transmitted infections. And this is
what we emphasize," said Kanyaruhango.