Medical Male Circumcisions

Western Cape Department of Health is actively promoting the elective male medical circumcision (MMC) programme to increase the uptake of MMC in the province. During 2013/4 the Department performed 16 596 MMCs and in 2014/15 15821 males went for the procedure.

Males between the ages of 15 and 49 may make an appointment at a facility to have the procedure done. The 30-minute procedure is performed by trained healthcare workers and holds many health advantages such as:

• Reducing the risk of HIV infection and other sexually transmitted illnesses.
• Improved hygiene.
• Reducing the risk of developing penile cancer.
• Reducing the risk of passing the virus that causes cervical cancer to their female partners. 

Medical circumcisions are safe, free and accessible to the public. The relatively lower uptake than expected may be explained by the fact that this is a complex matter dependent on behaviour change effected over time. The Department has put in place steps to encourage this behaviour change to increase the uptake of MMC, which includes:

• Exploring devices like the Cap-method and Uni-Circ (a bloodless procedure to circumcise men), which have been used by GPs as opposed to the surgical method currently used. 
• Reviewing the policy to possibly include neonates and boys younger than 10 years in the age groups. This is dependent on consultation on new devises, effectiveness studies and circumcision on other age groups requires evidence, which first have to be explored.

Working with partners:

• The Department has entered into an agreement with Metropolitan Health Risk Management with the aim of increasing HIV prevention strategies with MMC being one of them. Approximately 20 private GPs were trained on how to perform MMCs as part of the Metropolitan Health initiative. 
• The Department will ensure a sustainable supply of MMC kits to GPs who have been trained and deemed competent to perform MMCs. 
• Through the Department’s Business Development Unit (BDU) the department have agreements in place with a list of private providers for family planning and related service. The BDU is in the process of approaching private providers to partner with the department by offering HCT & MMC services at their sites, where the department will provide the consumables such as HIV rapid test kits and MMC kits. 
• Several Non-Profit Organizations have been contracted to support the department in MMC by creating local demand creation, providing clinical and operational staff that work in the MMC clinic.
• Traditional circumcisers have been engaged both nationally and provincially on ways of making this cultural practice safe. The Western Cape Government Health has been working with the Department of Cultural Affairs and Sport (DCAS) through inter-sectoral collaboration to support Traditional Circumcision. The department has undertaken to supply HIV testing and counseling to all initiates and the delivery of sterile surgical packs for use during traditional circumcision, as well as and post-operative counseling, where requested. Thus far approximately 20 rural districts traditional circumcisers were trained by CHAPS. The Department of Health also provide MMC kits to traditional circumcisers which consist of suturing material, blades, dressings (gauze and cotton wool), forceps antiseptic solution and bandages provided separately.

No adverse incidents such as complications or deaths have been reported by DCAS to Health so far which points to safer traditional circumcisions have been performed.

With upcoming school holiday fast approaching the Department will continue to ensure safe practices through on-going Inter-Sectoral collaboration with DCAS and the Traditional circumcisers. Circumcision Forums in the districts will continue to work hand in hand with the dedicated MMC teams in the districts

Know The Facts:

1. What is Male Medical Circumcision (MMC)? 
Male Medical Circumcision is the complete removal of the foreskin. 

2. Why should a man undergo MMC?

• It is the best option for your sexual and reproductive health. 
• It reduces the risk of HIV infection.
• It is the best method to reduce your risk of sexually transmitted infections such as syphilis and gonorrhea.
• It reduces your risk of penile cancer and your partner's risk of cervical cancer.
• Infections (STI's) and diseases.
• It ensures better hygiene.

3. What male circumcision does not do?

• Does not prevent pregnancy.
• Does not benefit the partner of an HIV-positive man.
• Does not reduce the risk of HIV infection during anal sex.

4. Where can a man go for a male medical circumcision?
Male Medical Circumcision takes place in local clinics, community health centres and district hospitals. A specially trained doctor or nurse will do the procedure.

5. What happens to a man when he decides to have a male medical circumcision?
At the health facility the man will be counselled and will be examined by the nurse or doctor to make sure that a circumcision can be done on him. It will be recommended that he has an HIV test. He will be given a local anaesthetic. The procedure takes about 30 minutes. The wound is stitched and he will be told how to keep the wound clean. Then he can go home.

6. How long is the healing process?
The wound takes about six weeks to heal. The man may not have sex or masturbate during this time otherwise the wound will take longer to heal.

7. Does a man still need to use a condom after circumcision?
Yes, the man must use a condom to reduce unwanted pregnancy and to reduce the transmission of HIV and STI's. The man's sexual ability will be the same as before the circumcision.

8. If a man has already been circumcised as part of his culture or religion, does he need another circumcision?
Many cultures and religions only partially circumcise the penis, however, for full health benefits a medical circumcision is recommended. 

9. Who can go for a medical male circumcision? 
Provided informed consent for the procedure is obtained by the medical practitioner, parents can have their male babies and children circumcised at various health care facilities. Men from 15 to 49 years can also visit their nearest clinic to undergo the procedure. 

10. Can a man be circumcised if he is HIV positive?
Yes, HIV positive men can be circumcised, however this does not protect your partner from contracting HIV and you should continue to use condoms at all times (even after being circumcised).