Bridging the divide on male circumcision in war on Aids

The decision by a cross-section of Luo Nyanza leaders to support the voluntary medical male circumcision has been hailed as a major breakthrough in the fight against Aids, which has devastated the region.

This week, Prime Minister Raila Odinga led MPs, the Luo Council of Elders and other leaders to talk on male circumcision before they closed ranks.

The Monday meeting was the fourth in a series under the Nyanza Task Force on Male Circumcision and a research team of Prof Kawango Agot and Prof Jeremiah Achola Ndinya. The first three meetings made little headway.

The debate at one time threatened to tear apart the politicians. The Prime Minister supported the male cut for HIV prevention, while the Luo Council of Elders was bent on “preserving the culture”.

At the meeting, council chairman Ker Riaga Ogallo said the community had accepted to mobilise members to go for the cut, following the scientific evidence presented by medical experts to the effect that the strategy reduced by up to 60 per cent, the chances of contracting HIV.

Mr Odinga met the elders, MPs and medical experts in a bid to bridge the gap and reduce the confrontations that the leaders from the community have been having in public over the cut. He said: “I know circumcision will raise a lot of eyebrows.

But there is evidence that it reduces infection by as much as 60 per cent.”

Mr Odinga continued: “We must face the reality. We should not just say that it is not our culture. We should emphasise more on the reason we are doing it.”

He also said pushing for the cut without knowing HIV status was futile, arguing that local leaders needed to take the test in public as was done by the US Democratic Presidential nominee Barack Obama when he visited the country in 2006.

He said that although the Government had been promoting other aspects of the Aids war, inclusion of circumcision would boost those efforts. Not all, especially the youth, could use condoms and abstinence as control methods, he said.

Ker Ogallo has in the past stood his ground, saying the practice was not Luo culture and the community needed time to embrace it.

But on Monday, he stepped down from his hard-line stance and accepted the cut provided it was voluntary and for medical purposes, not a right of passage.

He said: “Aids is killing us and we are going to kill it. But do not kill our integrity. Don’t kill what makes us Luos.”

The PM said Nyanza Province still had the largest number of infections despite spirited campaigns against it. But he maintained that the push for circumcision was an individual issue rather than a communal affair.

The meeting held at the Tom Mboya Labour College in Kisumu saw presentations by medical experts who included Dr Rex Mpazanje, representing the World Health Organisation and UNAids, Prof Kawango Agot and Prof Ndinya Achola from the Kisumu Randomised Controlled Research and Prof Alloys Orago of National Aids/STIs Control Programme (Nascop).

The experts presented data from three sets of research, which indicated that the cut was vital. Mr Odinga said the community should not stigmatise those who had accepted the practice, arguing that would reverse the gains.

Among MPs who attended were ministers Anyang’ Nyong’o, James Orengo and Dalmas Otieno. Others were Ayiecho Olweny, Oburu Oginga, Pollyns Ochieng’, Fred Outa, Shakeel Shabir and Olago Aluoch.

Medical Services minister, Prof Nyong’o, said that according to the latest reports, more people from the region were opting to go to hospitals for the cut, adding that the Government would provide affordable and eventually free services for those who have opted to be circumcised.

In most cultures, the practice is used as right of passage, and that was one reason elders expressed fears they were being encouraged to embrace other cultures.

But Public Service minister, Mr Otieno, said instead of opposing the cut on traditional grounds, elders should revive the positive aspects of Luo culture that would set them apart from the rest.

He said: “Let’s save our people to love our culture.” Women, religious and the disabled groups were not left behind. The special groups were among the first to publicly declare their support for the male cut.

They asked the Government to incorporate their ideas into the national policy set to be launched later this year.

“The cut is good, and as women representatives, we can only advise the Government and the researchers to bring the services down to the rural areas,” said author Asenath Odaga.

According to Mrs Odaga, information was not reaching the rural areas. She said: “Some men are silently taking the cut behind the backs of their partners, which has caused divisions in families.”

Ms Amina Akello of the Asalam Muslim Women Forum said the cut should be encouraged for hygiene and health.

“For us Muslims, it (the cut) is mandatory, but we would want the Government to bring the services down to the people,” Ms Akello said.

Bondo MP Oginga, and an assistant director of medical services, Dr Peter Cherutich, urged opponents of the cut to look at its health benefits.

“Were traditions to serve man or man to serve tradition?” Dr Oginga asked. Nyanza Province leads in HIV prevalence at 15 per cent, Dr Cherutich said.

The province, he added, needed to accommodate new ideas to bring down the risk of HIV infection. The country prevalence figure as contained in the Kenya Aids Index survey by Nascop stands at 7.4 per cent.

The survey found that 1.4 million adults in Kenya are living with the virus, with Nyanza contributing 50 per cent of these.

Abstinence

Dr Cherutich asked people to integrate male circumcision with known programmes such as counselling, abstinence and testing. “This is a preventive package that reduces the risk of HIV infection, but does not eliminate it,” he said.

Prof Agot, who was the study coordinator in Kisumu was ecstatic that they had finally jumped over the hurdle.

“In the idiom of the youths, I can say tumetoboa (we have made it). But it’s now time to settle down to work,” she said.

She said that the next major step was the official launch of the national policy on male circumcision.

In the meantime, the director of medical services is expected to send a circular that will give the go-ahead for the services to begin.

“Previously our hands have been tied and all that we have done was training. We now want to move into service provision,” Prof Agot said.