Adult male circumcision (MC) is a surgical procedure to remove the foreskin (prepuce) of the male penis. There are several proposed mechanisms for how male circumcision might reduce a man’s risk of HIV infection. The foreskin’s inner mucosal surface is more susceptible to HIV because it has more immune cells vulnerable to HIV infection than the external surface. Furthermore, the foreskin acts as a physical barrier, trapping HIV next to the mucosal surface of the penis for a longer period of time. In this moist environment, the virus can also survive longer, potentially increasing the risk of infection. Small tears in the foreskin as a result of intercourse could also promote entry of the virus. After circumcision the penile shaft and glans develops more epithelial keratinization, a process which makes the penis less susceptible to viral invasion.
Overall, studies have shown that 62% of adult males in Africa are circumcised. However, some studies in South Africa discovered that many men who thought had been circumcised during traditional initiation rites they still had intact foreskins, or were only partially circumcised. The 62% rate of circumcision differs with region and tribal groups. In particular, male circumcision is strongly tied to religious beliefs; almost all Muslim and Jewish men are circumcised. In Southern Africa, where the HIV epidemic is the most severe, rates of male circumcision are less than 20%.
MC as a surgical procedure has recognized risks if improperly performed such as serious infection, severe loss of blood, mutilation, penile amputation and death. Furthermore, the procedure requires some time for healing, and during that time there is a break in the epithelial (skin) surface of the penis. This incision site may be a portal for HIV entry and until fully healed, it may increase the risk of HIV infection.
Promoting circumcision for HIV-positive men is not recommended because trials showed no significant difference in HIV transmission from circumcised HIV positive men compared to uncircumcised HIV-positive men.
As with most prevention strategies, adult MC is not completely effective at preventing HIV transmission. Millions of circumcised men have become infected with HIV through heterosexual exposure to the virus. Men who receive adult MC may perceive that they are at decreased risk for transmission and, therefore, may not maintain other risk reduction strategies.
It is not known whether MC reduces the sexual transmission of HIV from men to women. Although a reduction in HIV incidence among men will eventually result in lower prevalence in men and therefore less likelihood that women will be exposed to HIV, currently there are insufficient data to know whether MC results in a direct reduction of transmission from HIV-positive men to women.
WHO recommends adult MC in settings where HIV is hyperendemic (HIV prevalence in the general population exceeds 15%), spread predominantly through heterosexual transmission, and where a substantial proportion of men (e.g. greater than 80%) are not circumcised.
Surveys conducted in Africa in both men and women have found that adult MC is acceptable (50 to 86 percent), provided that the procedure is safe, affordable and has minimal side effects or pain. Among the reasons cited include better hygiene, lower sexually transmitted disease rates, more modern/urban appearance, peer pressure and perceived attractiveness to women.
Accurate information about the intervention should be communicated; that MC provides only partial protection against the risk of acquiring HIV and that the reccommended procedure is done by trained medical personnel as opposed to fellow villagers which is the case in most African settings.
Saturday, 5 September 2009
Monday, 31 August 2009
Heroes Welcome For Mokgadi Caster Semenya
Semenya gestures after her arrival in South Africa, Tuesday Aug 25, 2009South Africans on Tuesday 25th August offered a befitting welcome to Semenya, at the O R Tambo International Airport, when she returned home from the event in Germany. Winnie Madikizela-Mandela, the former wife of Nelson Mandela, along with Semenya’s parents said: We are here to tell the whole world how proud we are of our little girl.
The gold-medal-winning teenager cried "Mama! Mama!" and reached out for her mother at the welcoming ceremony in the arrival area.
Semenya, who tried a few dance moves while the crowd cheered wildly, gave a thumbs-up before breaking into a broad grin and said: "Hi, everybody!"
Semenya's mother, Dorcus, wearing a traditional headdress said: We feel powerful because of her.
Semenya's return was given top coverage by local media, with the Times running a wraparound souvenir poster headlined "Welcome home Caster, our champ", with a life-sized portrait of the 18-year-old.
ANC Youth League President Julius Malema congratulated her on her win and said: Like Nelson Mandela, Caster Semenya today makes us very proud. Malema however questioned why there were so few white South African supporters in the audience saying, that if there were returning rugby stars there would be more white people.
The IAAF is subjecting Semenya to gender tests after its suspicions were aroused by her sudden improvement on the track, her muscular build and deep voice.
Eric Modiba, head of the Nthema Secondary School, from where Semenya graduated last year, told South Africa's Beeld newspaper: She was always rough and played with the boys. She liked soccer and she wore pants to school. She never wore a dress. It was only in grade 11 that I realised she's a girl.
Semenya's grandmother, Maphuthi Sekgala, 80, told South Africa's Times newspaper: It is God who made her look that way.
Despite this, critiques have said that Semenyas’ issue has been handled in the worst way possible. The practice by IAAF has been that names of athletes suspected of drug taking are NOT released until the second test comes back positive which was not the case with Semenya. Ironically, the suspicions about Semenyas gender were publicized even before the first test was done. This shameful behavior created room for speculations.
Moreover, her birth certificate clearly states she is female.
If tests will prove that she is a hermaphrodite, the world is waiting to see how the IAAF will snatch their medal back. Are hermaphrodites not human, worth world attention? Why then are they not allowed to compete and keep their medals? South Africa President Jacob Zuma, however, vowed that he would not permit her gold medal to be taken away, no matter what gender tests say.
The gold-medal-winning teenager cried "Mama! Mama!" and reached out for her mother at the welcoming ceremony in the arrival area.
Semenya, who tried a few dance moves while the crowd cheered wildly, gave a thumbs-up before breaking into a broad grin and said: "Hi, everybody!"
Semenya's mother, Dorcus, wearing a traditional headdress said: We feel powerful because of her.
Semenya's return was given top coverage by local media, with the Times running a wraparound souvenir poster headlined "Welcome home Caster, our champ", with a life-sized portrait of the 18-year-old.
ANC Youth League President Julius Malema congratulated her on her win and said: Like Nelson Mandela, Caster Semenya today makes us very proud. Malema however questioned why there were so few white South African supporters in the audience saying, that if there were returning rugby stars there would be more white people.
The IAAF is subjecting Semenya to gender tests after its suspicions were aroused by her sudden improvement on the track, her muscular build and deep voice.
Eric Modiba, head of the Nthema Secondary School, from where Semenya graduated last year, told South Africa's Beeld newspaper: She was always rough and played with the boys. She liked soccer and she wore pants to school. She never wore a dress. It was only in grade 11 that I realised she's a girl.
Semenya's grandmother, Maphuthi Sekgala, 80, told South Africa's Times newspaper: It is God who made her look that way.
Despite this, critiques have said that Semenyas’ issue has been handled in the worst way possible. The practice by IAAF has been that names of athletes suspected of drug taking are NOT released until the second test comes back positive which was not the case with Semenya. Ironically, the suspicions about Semenyas gender were publicized even before the first test was done. This shameful behavior created room for speculations.
Moreover, her birth certificate clearly states she is female.
If tests will prove that she is a hermaphrodite, the world is waiting to see how the IAAF will snatch their medal back. Are hermaphrodites not human, worth world attention? Why then are they not allowed to compete and keep their medals? South Africa President Jacob Zuma, however, vowed that he would not permit her gold medal to be taken away, no matter what gender tests say.
Sunday, 30 August 2009
A Sunday well spent
Today, I visited a German friend who lives in Rodley. This was after the church service.
While at the church, the pastor reminded us the importance of saying ‘Thank you’ in everything that comes our way. It was a powerful message and I enjoyed the service.
In Rodley, we had a full lunch, followed by a 30 minutes tour of the place. The walk was not only good for my health but also allowed me to appreciate the canal that runs through this town. The canal, built many years ago, runs all the way to Liverpool and many other places.
While at the church, the pastor reminded us the importance of saying ‘Thank you’ in everything that comes our way. It was a powerful message and I enjoyed the service.
In Rodley, we had a full lunch, followed by a 30 minutes tour of the place. The walk was not only good for my health but also allowed me to appreciate the canal that runs through this town. The canal, built many years ago, runs all the way to Liverpool and many other places.
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