HIV+ men can get circumcised too

Robin Muchetu Health reporter
MEDICAL male circumcision in Zimbabwe has been carried out in HIV negative men as a means to reduce infection by up to 60 percent. Why HIV negative men? Because the main aim is to try and save as many people as possible from being infected with the virus. However, trends have changed. Men living positively with the virus can now get circumcised too.

The World Health Organisation’s recommendations on Voluntary Medical Male Circumcision (VMMC) state that circumcision of HIV positive individuals is generally not encouraged. However, where an individual insists that he needs to be circumcised, further counselling and assessments are done to ensure that the individual is suitable to undergo the operation and will heal within the expected time.

According to Dr Owen Mugurungi, the director of the Aids and TB Unit at the Ministry of Health and Child Care, while VMMC is actually a tried and tested method in HIV prevention, some HIV positive men have also been circumcised under the programme.

“As a Ministry, we are currently rolling out the VMMC programme as an HIV prevention method. In actual fact, VMMC is one of the high impact HIV prevention strategies among others such as HIV Testing Services, Behaviour Change, the Condom programme and so forth. In this regard, we are offering male circumcision services to prevent an HIV negative person from acquiring HIV in the event of unprotected sex in a heterosexual relationship,” he said.

“This precaution is necessary as individuals with weakened immunity may develop other complications which they would not have had if they were HIV negative. While there is this precaution, the programme has circumcised some HIV positive individuals after such considerations have been made.”

Dr Mugurungi said an HIV positive man who is still convinced on getting circumcised will be provided with the service, but upon verification of a number of important factors.
The first step, he said, is to consider their general health status, that is, how well the individual is. The person needs to be in WHO stage one or two of the HIV progression. This stage of infection lasts for a few weeks and is often accompanied by a short flu-like illness. In up to about 20 percent of people are serious enough to consult a doctor, but the diagnosis of HIV infection is frequently missed.

If the patient is in stages three or four, circumcision is strongly discouraged and the person will not be circumcised. This stage lasts for an average of 10 years and is free from major symptoms, although there may be swollen glands and antibody tests will show a positive result.

Dr Mugurungi said the individual will also be screened for other existing diseases such as sexually transmitted infections.
Further, where available, the CD4 count is also done and it has to be at minimum of 350. If the CD4 count is already low, the individual is referred for antiretroviral therapy (ART) and circumcision is deferred.

“Finally, the individual is also counselled on the need to abstain from sex until the six weeks waiting period is over. For HIV positive individuals, the risk of passing on HIV is greatly increased if they resume sex before full wound healing because of the breakage of the skin and therefore if upon counselling there is reasonable indication that the individual will not adhere to the abstinence period, circumcision may not be offered in the interest of public health,” he said.
According to the Health Ministry, six percent of men that were circumcised in 2014 were actually HIV positive.

However, there is a misconception — which Dr Mugurungi — dismissed that once an HIV positive man is circumcised the chances of infecting a partner are low.
He said circumcising HIV positive individuals does not reduce their chances of passing on the infection to their sexual partners.

“It can only reduce their chances of being re-infected. Evidence that we currently have that supports VMMC is for preventing the acquisition of HIV from an HIV positive woman to an HIV negative man.

“The prevention of infection to the female partner works more as an indirect benefit which is more at a population level than at an individual level, that is, if fewer men acquire HIV due to circumcision, it eventually also reduces the number of female partners protected from HIV,” he said.

Age is also another factor to consider, reports say an 86-year-old man was recently circumcised which has had people asking when the best time is to get circumcised and when can one not get circumcised.

According to the Male Circumcision Policy in Zimbabwe, circumcision services are provided to adolescent and adult males, beginning from the age of 10 and upwards.
“There is no cut off age, although according to the modelling work in Zimbabwe the best age to offer services to all males is 10 years upwards, but we concentrate more efforts on the 13 to 29-year-olds where this will result in the highest number of new infections averted. So, if any male is above 10 years of age, then now is the best age to get circumcised — whether sexually active or not,” he said.

Some men, however, felt that it was a futile exercise to circumcise HIV positive men.
“The idea is to reduce infections so when one is already infected what is the point? People who are living with the virus need not to worry much about circumcision unless of course if they are doing it for hygienic purposes,” said Mr Gerald Masuku an Aids activist from the city.

Circumcision ensures that the male reproductive organ is clean as the foreskin will have been removed such that no bacteria accumulates on the organ. There is also some protection for the woman too as she may be spared form cervical cancer.

Other sections of the society practice male circumcision for cultural reason such as the Xhosa and Varemba.