Women have become a deciding factor as government is pushing to get boys and men undergo medical circumcision, which has the potential to reduce the risk of acquiring HIV by 60 percent, according to the World Health Organisation (WHO).
“Who said circumcision is all about men?” wondered Manuel Chimpaza, 31, while waiting for his turn in a queue dominated by boys as young as 10 at Chilomoni Health Centre in Blantyre.
Government is working hand in hand with Population Services International (PSI), Banja la Mtsogolo, Christian Health Association of Malawi (Cham) and Jpiego Malawi to provide circumcision near health centres in Phalombe, Mulanje, Nkhotakota, Lilongwe, Thyolo and Blantyre.
Apart from Chilomoni, other sites in Blantyre include Mbayani, Ndirande, Lunzu, Chilobwe, Bangwe and Chileka.
Mbayani resident Chimpaza’s voyage to Chilomoni might be a precautionary step to beat mixed stereotypes that frown upon those that are circumcised or not, but he candidly confessed being in the queue because of her wife’s support.
He said: “Behind every man being circumcised is an understanding woman.
“When I shared my intention with my wife, she told me to go on and pledged to support me until the wound heals because she understands this will reduce our exposure to STIs, including the virus which causes Aids, but also safeguard her from cervical cancer.”
Like many, he grew up thinking that circumcision was exclusive to cultural and religious rites of some tribes in the Southern Region. Since VMMC entails more than just partial removal or slitting of foreskin, he feared it would be a painful surgical process spanning hours on end.
But during the meeting in Chilomoni, it took less time. In less than an hour, Chimpaza had hopped from a reception tent where clients are counselled on what circumcision entails, on to the last tent where they recover from the ultimate surgery. In between, he was screened for HIV, STIs, blood pressure, body weight and other conditions.
“The tests are vital in determining the client’s immunity and mitigating the likelihood of having problems in healing process,” said one of the medics on site.
As Champaza was taking his turn, Emma Kholiyo a mother of one, was sitting in a bench along with four other women who had brought their children. She had come with two of her sister’s sons, one aged 10 and another 12.
“Gone are the days circumcision was a cultural or religious ceremony. Now, even women must take part in ensuring that every child has a minimal chance of getting sexually transmitted infections. That way, we will be protecting their lives and wives from HIV, cervical cancer and other infections resulting from impurities of male sexual organs,” said Kholiyo.
She said the media, especially radio programmes, is the main source of the information that stimulated her interest in male circumcision, particularly its best interest.
She reckons men cannot keep women out of the equation, saying: “It only makes sense that they involve us from the beginning because the circumcised need our support, as mothers and partners, to take care of their wounds and shoulder the burden of waiting for the six weeks of healing.”
Circumcision is an age-old tradition, especially among Yao and Lhomwe tribesmen as well as Moslems. Figures from the Ministry of Health show about 350 000 had gone through medically certified circumcision before government officially embraced circumcision as a supplementary life-saving strategy in October 2012.
“We have reached out about 50 000 Malawians since last year, meaning the circumcised population in the country has hit about 400 000. We plan to circumcise about 60 000 more by the end of the month of action,” said the ministry’s spokesperson Henry Chimbali.
However, Chimbali stressed that the traditional ABC—abstinence, being faithful and condom use—remains the backbone of the country’s approach as government is expanding complete removal of foreskin as a way of buttressing its quest for zero new infections.
Since 2005, research has shown low HIV prevalence in populations with high circumcision rates. Randomised controlled trials in Kenya, Uganda and South Africa showed it lowers the risk by 51 to 60 percent, but the World Health Organisation only adopted it in 2007.
Chimbali estimated that two million Malawians aged 15-49 need to be circumcised by 2018 to avoid 265 000 new infections, with some districts requiring as low as seven circumcision to put one life out of harm’s way and others 27. This means circumcision is neither a foolproof shield nor a licence to wanton sexual relationships which spread the virus.
With 10 in 100 Malawians living with the virus and slightly over 150 getting infected daily, PSI Malawi deputy head of party Chiwawa Nkhoma reports that the demand for circumcision rising.
“Our centres target at least 60 clients a day, but in Ndirande, Chilomoni and other places, the demand is overwhelming. In terms of age, we are seeing more and more males from age 10 to 29 than adults above three,” explained Nkhoma.
She reckons the adults are outnumbered because free-for-all circumcision coincides with the hours they are busy at work or because of the fear of spending six weeks without sex as the wound heals. The latter is more the reason women must be involved and couples must dialogue, she said.
“You cannot talk about marriage, care and support without involving women. Couples ought to discuss circumcision,” Nkhoma explained.