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MEC takes on TAC over circumcision device

<p>Kerry Cullinan</p>

August 30, 2012

Tension between the Treatment Action Campaign (TAC) and the KwaZulu-Natal health department over the use of a plastic device to circumcise men heightened yesterday following a departmental press conference at which the TAC was described as ignorant and mischievous.

Health MEC Sibongiseni Dhlomo said that the TAC had little knowledge about male circumcision procedures in KwaZulu-Natal and had gone out of its way to make negative comments.

Dhlomo called the press conference in Pietermaritzburg to respond to the TAC’s decision to ask the Public Protector to investigate the use and procurement of the Tara Klamp (TK) device in the province’s circumcision drive.

The Tara Klamp is a plastic device that is attached to the male foreskin for up to seven days during circumcision.

The province launched a mass drive to circumcise men in April 2010 after research found that circumcision could reduce a man’s risk of HIV infection by up to 60 percent. It uses both the traditional forceps method and the TK to circumcise men.

However, the TAC has described the TK, which is only used in KwaZulu-Natal, as “dangerous” and the cause of infection. Its criticism is based on a small study of the TK at Orange Farm during with 32 percent of men reported adverse effects.

But Provincial Head of Health Dr Sibongile Zungu said that her own sons, aged 12 and 13, had been circumcised using the TK during the July holidays.

“The TAC seems to be saying that we want to mutilate and hurt our people, but we would not do that. As a mother, I would not do that to my own children,” said Zungu.

Addressing claims that the province was favouring a supplier with government links, Zungu said that “there is only one supplier of authorised by the manufacturer to supply the TK in the country”.

So far, over 175 000 men in the province have been circumcised since 2010, almost 36 000 with the TK.

“Thus far, the department has had no adverse effects such as penile mutilation or erectile dysfunction or penile disfigurement,” said Dhlomo.

It was both quicker and cheaper to use the TK, as unlike with the traditional forceps method no sutures (stiches) were needed with the TK, said Dhlomo.

The total cost of the forceps method was R910 whereas the TK cost R595, with the actual device costing R195, he said.

Sanele Nkabini, part of the department’s circumcision team, said the TK device also enabled the department to circumcise more men as it was quicker and staff did not need to be highly skilled as they did not have to stitch the penis.

In addition, patients needed three follow-up consultations after being circumcised with forceps and only two with the TK, said the MEC.

Radio personality Ngizwe Mchunu said he had been circumcised with the TK and had “no problems at all”.

Dhlomo said that the national TAC seemed to be driving an agenda to undermine the TK and had “gone out of their way to tell TAC KZN to find adverse effects and report these to them”.

“[The TAC national] are well aware that they have not found any adverse effects but the TAC National is pressing them to say they have found mistakes,” added Dhlomo.

Officials at TAC’s Pietermaritzburg office confirmed that they had been instructed to find people who had problems after being circumcised with the TK, and one said they felt caught between their national office and the provincial health department, with whom they wanted to build a good working relationship.

However, the TAC’s Nathan Geffen said his organisation had received reports about serious adverse events “from both patients and doctors working in the KwaZulu-Natal circumcision programme” and had photograps to prove this.

“Either the department is in denial about adverse events or the Department’s monitoring of adverse events is less reliable than TAC’s ad-hoc efforts,” said Geffen.

“We reaffirm that the use of the Tara KLamp is a violation of basic medical ethics and its use is both irrational and irresponsible. Dr Dhlomo’s statement has failed to address our concerns and underlines the urgent need for a serious investigation into the use of the Tara KLamp.