Rwanda: Creating awareness among adult men to circumcise (A feature by Aimable Twahirwa, PANA Correspondent, Kigali)

Kigali, Rwanda (PANA) – Despite government’s efforts at scaling up voluntary medical male circumcision (VMMC) services in Rwanda as part for HIV intervention, challenges remain with respect to changing the mindset of adult men in the rural areas of the East African nation to undergo the procedure.

While some men believe that circumcision would increase sexual pleasure, the Government and health experts state that the acceptability of male circumcision as a strategy for HIV prevention and sexually transmitted diseases is key.

Phocas Munyabarenzi, one of the traders operating a small business in Burera, a mountainous rural district in the Northern Rwanda, is an adult person who has undergone male circumcision in a neighbouring referral hospital.

“I decided to be circumcised because my wife insisted that I should undergo the procedure so that I won't be teased anymore, but I was also told that this could enhance my partner's (sexual) satisfaction,” the 42-year-old father of four said.

But a few weeks after his circumcision, Munyabarenzi said he noticed that there was something abnormal in his body and his ability to have satisfying sex had reduced.

While circumcision is shrouded in myths in Rwanda, Munyabarenzi is one of the many rural residents who fail to comply with medical advice instructing him to abstain from sex for at least six weeks following the procedure.

Rwandan health officials argue that the most interesting benefit for men in undergoing the procedure was not about sexual performance, but instead as an important barrier to HIV infection where by it can reduce by 70 per cent, the risk of men getting HIV.

As of 2015, the HIV epidemic in Rwanda had stabilized at a prevalence of 3 percent, according to the latest Demographic and Health Survey (DHS) report.

Since 2013, male circumcision has been added to existing national priorities, after the Rwandan government and partners allocated funds to ensure the procedure is carried out hygienically. Before then male circumcision was associated with Muslims in this East African country of 11.3 million people, where the majority of people are Christians.

However, while adult men in Rwanda continue view circumcision, as a desirable procedure, some health experts stress the need to address barriers to services among this particular group

These include the establishment of health facilities that will be segregated by age to ensure the provision of high quality Voluntary Medical Male Circumcision (VMMC) services.

Among some of the recommended requirements for these VMMC facilities for adults are a waiting area which should be clean and comfortable and where by older men would able to sit apart from teenagers or children.

The Head of HIV, STI and Other Blood Borne Infections division at Rwanda Bio Medical Centre (RBC), Sabin Nsanzimana, explained that these efforts will be complemented with behavior change communication initiatives to address concerns of adult men in rural areas, by encouraging their partners’ support for circumcision.

“Currently, the major challenge is the mindset of the communities living in remote rural areas,” he said.

Results from random clinical trials that were conducted in Kenya, Uganda and South Africa, have established that male medical circumcision greatly reduced the risk of HIV infection among men, where by the procedure – which involves the removal of part or all of the foreskin from the penis – substantially reduces a man’s risk of contracting HIV during penile-vaginal intercourse.

However, in the Rwandan context, health experts are also convinced that the situation for male circumcision in the country still varies from place to place whereby in rural areas, communities’ awareness of the importance and purpose of male circumcision is still significantly low.

Dr. Antoine Rwego, a circumcision expert who also works as the focal-point in Rwanda of the US-government funded initiative under Centres for Disease Control and Prevention to address HIV/AIDS, noted that change in adult people’s mindset not to consider circumcision as a substitute for condoms.

"In whatever situation, adult people still need to understand that it is important to abstain from unprotected sex, even after their circumcision," he said.

Through a long term government target to conduct safe circumcision to 66% of male adults aged between 15 and 49 by 2018, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided funding for various HIV/AIDS control programmes, including voluntary medical male circumcision for HIV prevention, for 65,048 men across the nation.

Rwanda has also circumcised an additional 700,000 men whose majority are from rural areas using a new "non-surgical" plastic device commonly known as PrePex, comprising two rings and an elastic band, that cuts off blood supply to the foreskin, which loses sensation and shrivels.

Both Rwego and Nsanzimana are, however, convinced that the situation is slowly changing and people are slowly being sensitized that penile circumcision does not fully protect them from HIV transmission.
-0- PANA TWA/MA 24May2016

24 may 2016 10:12:37

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