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Kenya Govt launches male cut as HIV preventive measure By:Catherine Achienga , Posted: Mon, Nov 24, 2008
The Ministry of Health has officially launched voluntary male circumcision as part of its comprehensive national HIV prevention strategy.
One billion shillings has been set aside to facilitate acquisition of materials for the programme over the next two years.
Six districts in Nyanza province have been earmarked to kick start the Programme before it is rolled out to other parts of the country.
Years of simultaneous studies carried out in Uganda, South Africa and Kisumu in Kenya proved male circumcision reduces HIV infection in men by 60%.
The findings are endorsed by the World Health Organization.
The ministry of health on Monday took the bull by the horns and officially endorsed voluntary male circumcision to be integrated as part of its existing prevention programmes by giving national guidelines as well as a launching a clinical manual.
However the ministry is quick to caution against the notion that male circumcision is the answer to the rapid spread of HIV.
In addition family health international has received a 1.5 trillion shillings grant from the Bill Gates Foundation to establish a male circumcision consortium over the next 5 years.
The consortium will be charged to conduct further research and training activities on the safest and most effective ways to provide voluntary male circumcision as a preventive measure to HIV. Adoption of male circumcision as a preventive measure will see Kenya make great strides in its war against the epidemic.

Male circumcision made easier
NAIROBI, November 24 - The government has set aside Sh1 billion to finance voluntary male circumcision programmes to be carried out in all public hospitals across the country.
Public Health and Sanitation Assistant Minister James Gesami said on Monday said the initiative was aimed at reducing HIV prevalence rates in the country by 60 per cent.
"Whereas circumcision can avert so many HIV infections, if we don't use it properly in terms of using septic techniques, we shall increase again the number of HIV infections," the Assistant minister warned.
(Recent studies have shown that HIV infections can he reduced by circumcision but experts say it is not a deterrent against getting infection).
Mr Gesami stated that the national guidance for the voluntary male circumcision was developed early this year to provide a broader framework for its integration into the existing prevention programmes.
He said that a clinical manual for male circumcision had also been developed to set the standards for the provision of medical circumcision services.
The assistant minister however observed that careful planning and preparation was critical to ensure that the circumcision services were safe and accessible and emphasised the need for the operations to be done under hygienic conditions.
"Traditional circumcisers should use septic techniques by not using one knife on several individuals," he pointed out.
Speaking at the same time, World Health Organisation country representative Dr David Okello however cautioned that circumcision should not be used as an excuse for irresponsible behaviour.
"Circumcision should be promoted along with other HIV prevention strategies including safer sex, reduction in the number of sexual partners, plus the correct and consistent use of condoms," Dr Okello said.
He explained that sub-Saharan Africa remained the most heavily affected by HIV/AIDS accounting for 67 per cent of all people living with HIV/AIDS, and 72 per cent of HIV related deaths in the year 2007.
The WHO representative said recent statistics indicated that the percentage of people living with HIV/AIDS had remained stable at 50 per cent globally since 1990.
"In Kenya for example, the number of women living with HIV/AIDS is 1.5 times that of men," he stated.
On the mode of transmission, the WHO representative said evidence pointed at significant HIV transmission in homosexuals, drug users and commercial sex workers especially in sub-Saharan Africa.
He said that proven HIV prevention strategies exist for every mode of HIV transmission be it sexual, blood borne or mother to child infections.
He said that others included the use of microbicides, AIDS vaccine and probable secondary effect of antiretroviral therapy that continue to be investigated.
Dr Okello welcomed the move to introduce the free voluntary and informed medical male circumcision as an effective strategy for HIV/AIDS risk reduction in men.

Women to promote male cut
By JOHN NGIRACHUPosted Monday, November 24 2008 at 21:05
Spurred on by reports of a significant increase in HIV infections among married couples, health officials want to involve women in the drive to have more Kenyan men undergo circumcision.
Speaking at the launch of the voluntary male circumcision programme at Panafric Hotel, Nairobi on Monday, Public Health and Sanitation assistant minister James Gesami said the ministry would provide free counselling for couples on the benefits of male circumcision.
Counselling will be part of Government's strategy to promote the male cut in Kenya, partly funded by the Bill and Melinda Gates Foundation and the US Government.
This follows recent release of data from the Kenya Aids Indicator Survey that shows two-thirds of Kenyan adults infected with HIV are legally married or cohabiting and that in one of every 10 marital unions, at least one partner is living with HIV, forming what doctors call 'discordant couples'.
Married couples
Dr Peter Cherutich, head of the national task force on circumcision, said counselling is critical for both married and unmarried couples.
"There are cases where the husband sneaks out for circumcision and the wife interprets that to mean that he is preparing to become promiscuous, or that it will have an impact on their sexual relations... Women have to be involved for the full benefits to be felt," Dr Cherutich said.
He said the one-month healing period may also create problems as women may not understand the need for prolonged abstention from sex.
Parents will also be advised on how to counsel their sons facing "the cut."
Research has also shown that the male cut markedly reduces chances of infection with the human papilloma virus that causes genital warts and cervical cancer - the leading cause of cancer-related deaths in Kenya - by between 60 and 70 per cent.
It also reduces chances of infection with venereal diseases.
Public hospitals
Hospitals in Nyanza have recorded a surge in people seeking the services at public hospitals since circumcision was endorsed by the area's politicians.
But officials say hospitals first must be accredited to offer the services.
The task force has already developed a manual and guidelines for circumcision and come up with guidelines on it.

$18.5 Million Grant Makes Male Circumcision a Top-Tier HIV Prevention Strategy -- November 24, 2008
NAIROBI, Kenya - Male circumcision is gaining recognition as a fundamental practice for limiting the spread of HIV across sub-Saharan Africa. Three conclusive studies conducted in African countries, including Kenya, have shown that becoming circumcised dramatically reduces a man's chances of acquiring HIV from an infected woman. The challenge now is to transform this clinical knowledge into a public-health strategy that can save millions of lives.
Family Health International (FHI), the Bill & Melinda Gates Foundation, and the Government of Kenya have come together to address this challenge. FHI has received a five-year, US$18.5 million grant from the Gates Foundation to establish the Male Circumcision Consortium (MCC), a partnership with the University of Illinois at Chicago (UIC) and EngenderHealth.
The Consortium will work within the framework of the National Guidance for Voluntary Male Circumcision in Kenya and with a range of health care providers to improve and expand voluntary male circumcision services in Kenya. These efforts will be coordinated through the National Task Force on Male Circumcision at the Ministry of Public Health and Sanitation and, in Nyanza Province, through the offices of the provincial directors of public health and sanitation and of medical services.
The government initiative is also supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and other partners.
The Consortium, in consultation with the Government of Kenya, will conduct a range of research and training activities to determine the safest and most effective ways to provide voluntary male circumcision services. It will also help Kenya provide comprehensive and accessible HIV prevention in areas with the lowest levels of male circumcision and the highest prevalence of HIV.
The Consortium will focus primarily on Nyanza Province, but the impact will be national, says Dr. Mores Loolpapit of Family Health International, who is senior manager of the Male Circumcision Consortium in Kenya. "This initiative advances the Government of Kenya's national strategic plan to reduce transmission of HIV in Kenya," he adds. "It will generate knowledge that the government can use to implement its national guidance for voluntary male circumcision in Kenya and will likely influence voluntary adult male circumcision programs worldwide."
Clinical trials of adult male circumcision conducted in Kenya and Uganda showed that medically performed circumcision reduces the risk of acquiring HIV by approximately half. A similar trial in South Africa showed a 61 percent reduction in HIV infection among circumcised men.
"This pivotal research has led authorities in eastern and southern Africa to initiate support for widespread provision of circumcision services," says Robert Bailey, professor of epidemiology at the UIC School of Public Health. Bailey was the lead researcher of the Kenyan study and is a lead researcher for the Male Circumcision Consortium.
After reviewing the results of the three circumcision trials, experts convened by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) concluded that the evidence that male circumcision provides partial protection against HIV infection was compelling. They recommended that safe and voluntary male circumcision be considered part of a comprehensive HIV prevention strategy. The Consortium's partners have worked closely with WHO to ensure that the Consortium's objectives support the WHO/UNAIDS recommendations, and that its activities complement the global health community's efforts to reduce the number of new HIV infections by increasing the number of circumcised men.
The Male Circumcision Consortium's objectives are to:
1. Support the Government of Kenya and other local partners in developing and implementing a national male circumcision strategy.
2. Expand a male circumcision research and training center in Kisumu to train providers, build the capacity of health facilities, and monitor clinical outcomes.
3. Identify and address any misunderstandings about male circumcision for HIV prevention.
4. Conduct research to identify the safest, most effective ways to provide voluntary male circumcision as part of a comprehensive package of HIV prevention services.
"Expanding male circumcision services is a great opportunity to engage men to take greater responsibility for HIV prevention," says Feddis Mumba, Country Director, EngenderHealth-Kenya. "By reaching a population that does not usually access health services, we can maximize opportunities to educate men about behaviour change and the importance of shared sexual decision-making, which would improve health outcomes for both men and women."
About Family Health International
Since 1971, Family Health International (FHI) has been at the forefront of public health research, prevention, care, and treatment in the developing world. FHI delivers services and conducts research in HIV/AIDS, other infectious diseases, and reproductive health to improve the lives and well-being of some of the world's most vulnerable people. For more information on the Male Circumcision Consortium, click here.
About EngenderHealth
EngenderHealth works to improve the health and well-being of people in the world's poorest communities by transforming the quality of sexual and reproductive health services. EngenderHealth will contribute to a national training plan and system to build a skilled health work force to provide male circumcision, and will conduct research to assess the feasibility of non-physicians (e.g., nurses) providing circumcisions and the efficacy of outreach efforts to increase access to these services. For more information, visit EngenderHealth's Web site.
About the University of Illinois at Chicago
Since 1995, UIC's Robert Bailey and colleagues have conducted research on male circumcision and HIV infection in Africa. UIC's portion of the grant will be used to expand a medical circumcision training center to build capacity in Kenyan public health facilities and among private practitioners to provide safe circumcisions in the context of full HIV-prevention services. UIC investigators and collaborators will also conduct research to evaluate the safety and quality of circumcision and other HIV-prevention services.
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