Scientific research trials have theoretically proven that medical male circumcision can protect men from HIV infection by up to 60%. Now a study of a community of men who, over the last three years, have taken up medical circumcision, has shown the practical benefits of the intervention over a sustained period of time. The Bophelo Pele Medical Male Circumcision Centre in Orange Farm, run by the Centre for HIV and AIDS Prevention (CHAPS), is the first to run a public sector service offering medical male circumcision following research showing its benefits. Since its formation three years ago, the centre has been circumcising about 1 000 men between ages 15 and 49 per month on average. The review of the service shows that the intervention has dramatically reduced HIV acquisition among men in the Orange Farm area, south of Johannesburg.  

‘€œWe found that the risk of them getting HIV after circumcision remains reduced in that about 76% of those people that we’€™ve circumcised, who were HIV-negative in 2007, still are HIV-negative today’€, says Dr Ntlotleng Mabena, Operations Manager for CHAPS.

To arrive at the conclusion the study took into consideration factors including the risky sexual behaviour that the men still take.        

‘€œWe were actually trying to see if our counselling intervention also has an effect in terms of people reducing their risky behaviour. What the study found, unfortunately, is that men in this community are still not using condoms as optimally as they are supposed to use… People will use condoms with their not-so-frequent partners, but won’€™t use condoms when they sleep with their frequent partners’€, Dr Mabena says.

But this is a worrying trend which remains difficult to understand.

‘€œWe put in a lot of effort in counselling people about risky behaviour and use of condoms. So, it’€™s quite worrying to find that all these efforts are not really translated into actions by people who get this thorough counselling. There are a lot of arguments. We can speculate in trying to identify why people don’€™t use condoms. But, ultimately, we really don’€™t know what the reason is behind that’€, she says.

Asked if some men think that because they are now circumcised that they are actually protected and, thus, using condoms is not really a priority, Dr Mabena said:          

‘€œOne big argument before the whole rollout of circumcision was that circumcision might encourage men to have indiscriminate sex without considering condoms and all those things. They may translate the message of reduction of HIV as a complete protection. What we found in this study is that there has not been a change in behaviour in terms of men engaging in risky sex. We compared a group of uncircumcised men to circumcised men. Both of them behaved the same.

The circumcised men do not assume that the circumcision protects them better or completely. The behaviour is more or less the same’€.

Having said that, Dr Mabena is on a mission to encourage as many men as possible to circumcise. The Orange Farm Medical Male Circumcision Centre is a model on which the national Health Department has based the rollout of medical male circumcision across the nine provinces.

‘€œWhen an opportunity presents itself to action in order to reduce the risk of HIV infections, all responsible people should grab such opportunities with both hands’€, according to MEC for Health and Social Development in Gauteng province.  

MEC Mekgwe has set a massive target for medical male circumcision. She says by the end of 2012, about 125 000 men will have been circumcised in Gauteng.  

‘€œ(It’€™s) because you can see the zeal, the will, but also the way our communities are responding to this particular issue. We have committed to bring the service closer to where people live’€, she says.

But Mekgwe was also quick to state that the Abstain, Be faithful and Condomise message remains relevant as ever. She said being circumcised is not a license to have irresponsible sexual behaviour or too have multiple sexual partners.