“I was scared about the whole process but with the information I had received, I was determined to get circumcised,” he says. “I feel more confident and I am happy this decision helped me to finally get tested for HIV, so I know my status.”
Swaziland has the highest HIV prevalence rate in the world, estimated at 26 per cent of adults in a total population of 1.2 million. With compelling evidence that male circumcision can reduce the risk of heterosexually-acquired HIV in men by 60 per cent, the government decided to launch a national programme in January 2011, to raise awareness and encourage voluntary medical procedures.
Two years on, 10,000 men have been circumcised and officials estimate about 90 per cent of Swazi men are now aware of the issue. No mean feat in a country which does not traditionally practice circumcision.
|The workplace is an effective entry point to provide sexually active men with the necessary information about circumcision."|
“The workplace is an effective entry point to provide sexually active men with the necessary information about circumcision,” says Khombi Nkonde, the ILO’s National Project Coordinator in Swaziland.
“As they come to work every day, we can reach them with messages that highlight the benefits and help to dispel myths and misconceptions. We collaborate with health specialists and accompany the men in their decision-making process.”
The benefits of circumcision include reduced HIV transmission rates from infected women to men; reduced transmission of ulcerative sexually transmitted infections; reduced incidence of human papillomavirus in males, which in turn provides protection to women from cervical cancer; plus improved hygiene and some reports of increased sexual satisfaction.
The training sessions allow space for discussion on concerns and misunderstandings about circumcision. One of the most common myths is that the foreskin, once removed, is used to make a spice; that its removal reduces libido and that the operation is very painful. There are also worries about what the Bible says about circumcision.
Nkonde acknowledges that it can be hard to sell the idea in a culture which is not used to circumcision.
“We deal with these issues very carefully, by explaining the scientific facts and by using champions and trusted personalities like traditional leaders or soccer players who have been circumcised and had a good experience,” she explains.
HIV Prevention in Swaziland: the role of the workplace
Workplaces partnering with the project already have an HIV/AIDS committee in place, a network of peer educators and a workplace policy and programme. These are helpful for providing on-going support and information, since men often need time to make the decision following the training sessions. Employers are encouraged to be flexible and to assist workers who decide to go ahead, by adapting schedules to their medical needs.
The procedures are carried out by qualified doctors and trained nurses in properly equipped settings, such as government or private clinics. They also provide follow-up care.
“By 2015, it is foreseen that Swaziland – a country with a generalized HIV epidemic and low prevalence of medical male circumcision – will have offered voluntary medical male circumcision to at least 80 per cent of adult men,” says Vusi Maziya, Programme Manager for Male Circumcision in Swaziland.
While the uptake is already very encouraging, Cloepas Sibanda, from the Ministry of Labour and Social Security, stresses it is not a substitute for condom use.
“There is a danger that circumcised men will feel they are invincible from HIV, hence the need to emphasize consistent and correct condom use even after circumcision,” he says.
The ILO promotes circumcision as part of a combined prevention package that includes counselling and testing; treatment for Sexually Transmitted Infections, (STI), and information about safer sex practices and the correct, consistent use of male and female condoms.
The ILO project in Swaziland is supported by the United States Department of Labor (USDOL) and the United States President Funds for AIDS Relief (PEPFAR).