23-10-12 Report: Male Safe circumcision too late too slow.

Halima Athumani Civil society organisations in Uganda are worried that government under the ministry of health is not doing enough to scale up safe male circumcision.

The Ministry of Health launched the safe male Circumcision policy toward the end of 2010. This was four years since research found that medically performed male circumcision reduces the risk of HIV infection in men by an average of 60 percent.

The National HIV and AIDS strategic Plan 2007/2008- 2011/2012 recognises modeling results that revealed that the incidence rate of new HIV infections could be reduced by up to 40 percent with male circumcision as one of the HIV prevention interventions.

However, the report, titled Too little too slow, shows that the policy did not come with the much needed urgency in implementation.

Richard Hasunira the HIV/AIDS advisor HEPS-Uganda notes that the lack of government leadership in the implementation of the safe male circumcision has largely been the case with the national response to the HIV-epidemic.

In the 22 page report, its said that the roll out of SMC in Uganda has so far been driven by PEPFAR and not the ministry of Health and government as it should.

This is proved by the fact that Uganda does not have a costed work plan for the roll out of the exercise. Adding that, there has not been any systematic costing of the intervention or a written-out fundraising plan. Until now there is still no operational plan.

Hasunira says this is despite the target of circumcising 4.5 million men in the next five years. This meant that for 2012, there was supposed to be a big massive campaign to circumcise about 1.2 million men. However, according to the ministry of health records, only 380,000 have been circumcised.

//Cue in: The target was Cue out:not yet in place.//

Its also noted that the national SMC taskforce does not have regularly scheduled meetings to discuss progress, address challenges and guide the rollout of the intervention. Male circumcision is also largely funded by donors and there are no specific government allocations for SMC.

Hasunira says until todate, the civil society HIV prevention working group has tried to call them to a meeting to be facilitated by them all in vain. //Cue in: The coordination at Cue out:on a quarterly basis.//

The report also concludes that there is high unmet demand for safe male circumcision throughout the country. Some service providers sponsored by PEPFAR and UNAIDS are using innovative ways to deal with the high demand while others are just facilitated enough to do the cutting.

Hasunira defines the SMC infrastructure and logistics as a cocktail of best practices and poorly planned initiatives that represent a waste of precious financial, human and material resources.

//Cue in: You find state Cue out:problems than benefits.//

According to the report the key messages have tended to revolve around partial efficacy of safe male circumcision and the need to continue with the ABC (Abstinence, faithfulness and condoms) and other prevention measures, but have not necessarily been uniform across implementers.

Other findings include the limited role of women in the exercise, limited consideration for human rights of clients including informed consent and confidentiality and the poor management of negative attitudes myths and misconceptions of the public.

The survey was carried out in the districts of Budaka, Paliisa, and Kayunga circumcision sites.