Page last updated at 02:14 GMT, Friday, 26 February 2010

Circumcision: Zimbabwe's latest anti-HIV weapon

By Steve Vickers
BBC News, Harare

Lovemore bravely looks on at the work of the doctor and nurse as they perform the circumcision.

Surgeons carrying out circumciscion
The operation is done under local anaesthetic

"It's numb, man, I can't feel a thing," he says.

"It reduces the risk of transmitting HIV, so whatever's needed for me to be safe, I've got to do it. But I intend to remain faithful to my wife."

Lovemore is one of about 3,000 men who have been circumcised since Zimbabwe's government launched a programme in mid-2009.

In the next eight years the government aims to carry out the operation on 80% of all young men in the country - three million people in all.

Circumcision is not widely practised among Zimbabwe's cultural and religious groups, but the centuries-old procedure is now regarded as a key weapon in the country's fight against the spread of HIV and Aids .

Trials in Kenya, Uganda and South Africa have shown that the operation, in which the foreskin is removed from the penis, reduces by 60% the risk of a man contracting HIV - the virus that causes Aids.

Condoms and abstinence

Zimbabwe has one of the highest HIV prevalence in the world - 13.7% in the 15 to 49 age group according to Ministry of Health statistics from 2009.

Dr Karin Hatzold
Male circumcision should not be sold as the magic bullet
Dr Karin Hatzold
Population Services International

The government says the figures have been improving since 2007, when prevalence was more than 18%.

Officials say this is largely due to promotion of condoms, abstinence, and faithfulness to one partner.

Talent, who is 20 years old and single, is well informed of the risks of contracting HIV and is prepared to have the surgery. He is also aware of the abstinence message.

"I'm doing it for sexual hygiene, I understand that it reduces the risk of you getting infected with HIV," he says.

"But it doesn't permit you to then go and sleep around."

But some revellers at a Harare nightclub were less well-informed about the procedure.

"I'm really concerned about whether you'd live after the operation, because some people bleed to death," said one young man.

"It's a dangerous operation from what I've heard."

And 25-year-old Methembe is completely against the idea.

"I won't get circumcised, never. It would affect my sexual appetite. But for those who want, it's their choice," he said.

"Get circumcised, but you must still use condoms. Those people who are queuing for the operation believe that they will be immune to HIV, but they must know that they should also use condoms."

'Most effective'

Patients are given counselling and HIV testing before undergoing the operation, which is free of charge.

Those who test positive are advised not to have the surgery, as it could be bad for their health.

Government publicity poster for circumcision
The programme was accompanied by an advertising campaign

Circumcision reduces the risk of HIV infection because the inner layer of the foreskin is particularly susceptible to tearing and abrasions during sex, allowing the virus to enter the bloodstream more easily.

Dr Karin Hatzold, whose US-based group Population Services International sponsors the project, says circumcision will have a huge effect.

"It's the most effective intervention that we know today which can really save a lot of lives in terms of HIV acquisition," she says.

"But 60% is not 100%, so male circumcision should not be sold as the magic bullet.

"All the other behaviour interventions [such as abstinence and faithfulness] as well as the use of male and female condoms are as important, so they should all be used together."

The operation is carried out under local anaesthetic using the most cost-effective technique, known as the forceps method, at a cost of $40 (£26) for each patient.

The male circumcision programme has recently been taken to the armed forces, and it will be expanded further this year.

Zimbabwe has ramped up its expenditure on HIV prevention in recent years - and it will be hoping its latest programme reaps suitable rewards.

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