Cape Town - Parents of newborn and young boys could have their children circumcised at Western Cape clinics or hospitals as provincial health authorities aim to boost the number of medical male circumcisions (MMC).
Mark van der Heever, spokesman for the provincial Department of Health, confirmed the plan to explore this initiative, which had proven effective in reducing HIV transmission.
He said one of the game changers considered by the province was to introduce circumcision as early as possible, and the aim was to target infants and young boys under 10. The department was also considering using non-surgical methods such as Plastibell, otherwise known as Cap – a clear plastic ring with a deep groove designed for circumcising infants.
“The policy is being reviewed at present to explore what obstacles there were and come up with game changers. One… is to include neonates and boys younger than 10 years. We are exploring using devices like the Cap method and Uni Circ… used by GPs in the province as opposed to surgical methods used.”
Despite its success in keeping HIV/Aids prevalence at the lowest in the country at only 5 percent, the Western Cape is battling to roll out the MMC – considered a key intervention in reducing the transmission of the pandemic.
Scientifically proven to reduce HIV infection by 60 percent, MMC was launched in 2011. So far about 1.5 million men around the country had been circumcised, but in the Western Cape the number had remained dismally low at less than 30 000 last year.
The country has an overall target of more than 6 million men by next year.
Van der Heever said this year’s uptake of the initiative had remained low as only 15 821 men were circumcised during the 2014/2015 financial year – a drop from the 16 596 men circumcised during 2013/2014.
Last year the City of Cape Town performed just over 6 000 circumcision procedures in the metro partnering with NGOs.
The low uptake of MMC in the province had been blamed on lack of education and sometimes the rejection of the initiative among poor populations.
HIV experts have said while MMC was “very new” among the province’s majority population of coloured people, which traditionally didn’t practice it, for black communities the initiative was often rejected as undermining traditional circumcision.
Van der Heever couldn’t give timelines of when the policy review was expected to be concluded, saying it was unlikely to be before the end of this year as circumcision of the young boys required evidence. Research was still needed on how many infections circumcision would avert.
“Consultation regarding new (circumcision) devices also requires evidence and cost-effectiveness studies,” he said.
The move to start circumcising at an early age was welcomed by health experts, with the head of TB/HIV Care, Harry Hausler, describing it as a move in the right direction.
“I strongly believe that the priority should be sexually active men as that will prevent new infections, but as a long-term solution I think circumcising young boys will also have huge benefits. We need to make MMC a routine part of HIV-testing and counselling campaigns to make sure it reaches a wider population of men and boys.”
Dr Solly Lison, a Sea Point GP, also welcomed the initiative, suggesting that the earlier men were circumcised the better the outcomes. “Circumcising early is associated with a lot of convenience. Not only is it linked to less bleeding as the blood clots quickly, but the foreskin is also less sensitive so there is less pain. Children also tend not to remember it so there is less trauma associated with it.”
To ensure that it was done as safely as possible, the province had also trained GPs and traditional surgeons or circumcisers.
Additional to training, private doctors and traditional surgeons would be supplied with circumcision kits and first aid kits such as antiseptics, dressings and blades.
Traditional surgeons would also receive protective clothing and containers as shelters to perform the procedure.
Van der Heever said with traditional circumcision season approaching over school holidays, traditional circumcisers were expected to get more surgical stock refills.
“We issue as many kits as traditional circumcisers would need. One per initiate as it is done with MMC,” he said.
To get the wheels moving in boosting MMC numbers, the department had since entered into an agreement with Metropolitan Health Risk Management with the aim of increasing HIV prevention services, including MMC.
“GPs in private practice have been trained by the department supported by Centre for HIV Aids Prevention Studies (Chaps – a public benefit organisation that drives MMC). The department will ensure a sustainable supply of MMC kits to GPs who have been trained and deemed competent to perform MMCs,” said Van der Heever. “This partnership could potentially increase access to MMC services across the province.”
The SA Clothing and Textile Workers Union and the TB/HIV Care NGO had also been contracted to support the department in its MMC programme through social mobilisation, communication campaigns, and evaluation and monitoring.
It was not all gloomy though.
Van der Heever said although the province had not reached its MMC targets, the outcomes had been safer as there were no reported complications or deaths in the Western Cape so far.
Cape Argus