Peter Otieno, a 25-year-old taxi driver in Kisumu City, the capital of Kenya’s western Nyanza Province, is considering getting circumcised, he said “I have heard about male circumcision as a way of reducing one’s chances of getting infected [with HIV]”.
His only concern is the reaction of his friends. “I know my peers would ridicule me,” he said.
Otieno’s fears are not misplaced. Robert Ogol, a recently married man in his early thirties, said he faced mockery from his friends after being circumcised.
Both men are members of an ethnic Luo community in Nyanza that traditionally does not practice circumcision, but is being introduced to the idea of male circumcision as a strategy for HIV prevention as part of a government plan to roll out the procedure nationally.
The rollout, due to be launched in Nyanza in late September, is already facing problems; according to local media, members of the Luo Council of Elders, an advisory cultural body that wields considerable influence, have threatened to disrupt the launch unless they are properly consulted.
Nyanza Province has the highest HIV prevalence in the country – 15.3 percent – highlighting the need for more aggressive prevention strategies.
In August, Kenyan Prime Minister Raila Odinga and Health Minister Peter Anyang’ Nyong’o, both ethnic Luos, urged cultural leaders to embrace male circumcision, which research has shown can significantly reduce a man’s risk of contracting HIV.
However, the Council of Elders are against the idea of promoting mass circumcision. “We have no problem with male circumcision … as long as it is voluntary; but if anybody thinks they can force something alien on our community, then they are mistaken,” Riaga Ogallo, chairman of the Luo Council of Elders, confirmed.
He is also worried that the emphasis on male circumcision could encourage young men to have unprotected sex.
Dr Kawango Agot, a researcher with a joint project of the Universities of Nairobi, Illinois and Manitoba (UNIM), which conducted circumcision trials in Kisumu, said conflicting messages from various leaders could prove counter-productive to the goals of the programme.
“It is important to let people know that male circumcision is just one of the many initiatives to curtail the spread of HIV, and it is not effective on its own, unless combined with other methods like condom use and faithfulness,” she said. “Otherwise we could end up with a very dangerous situation.”
Dickens Omondi, a project coordinator with IMPACT-RDO, a local reproductive and sexual health NGO promoting male circumcision in Nyanza, said that his organisation’s greatest challenge was dealing with conflicting views in the debate on circumcision.
Various efforts are being made to prepare for the rollout: IMPACT-RDO is developing educational materials that will help men and the parents of boys to make informed decisions about the procedure; UNIM and the government are holding consultative meetings with religious, cultural and community leaders, health sector professionals, and young people.
In advance of the government programme, a pilot male circumcision project by Marie Stopes Kenya, a reproductive health NGO, has carried out more than 3,000 clinical circumcisions in Nyanza Province since April 2007.