I decided to get circumcised after 21 years: Joseph

There is a common misbelief that being circumcised is a sin since circumcision would change God’s creation—but numerous studies have demonstrated that male circumcision (MC) has a number of health benefits.

Joseph Anthony, from Mgaza village in Morogoro narrates to Your Health how he got motivated to be circumcised after living with the foreskin for 21 years.

Just like many other circumcised men, Joseph recalls that peer-influence triggered his decision to get circumcised.

He further recalls that it was back in July 20 this year when he first heard about the AIDS Free Tanzania-Voluntary Medical Male Circumcision (VMMC) programme offering the male circumcision services at no cost to clients, implemented by Jhpiego.

“There’s a friend of mine (Samadu Abdul) who advised me to go for circumcision. I did not talk to my parents about my decision. I did it alone by going to the mobile clinic and afterwards I returned home,” says Joseph.

Male circumcision is the surgical removal of the foreskin, the tissue covering the head (glans) of the penis. The procedure becomes more complicated and riskier in older babies, children, and men, according to medical sources.

Joseph who lives with his parents and his young brothers, belongs to a group of young men at the village who have found a way to put food on their families’ tables: making mud bricks.

He makes about Sh240,000 from the bricks, he says, depending on how good business is, and for the rest the family, they depend on agriculture.

Why the low turnout?

In many Tanzanian communities, older men (over 25 years of age) have not come forward for VMMC services. Reasons for low demand among this group of men may vary across geographic, cultural contexts and influence of circumcision related stigma.

Such barriers to MC uptake include: a long distance to the health facility, a decrease in male and female sexual satisfaction and peer influence against MC.

But for Joseph, a long distance to the health facility was not a factor that prompted him to delay for 21 years to undergo circumcision, but the economic hardship.

According to Dr Kanisiusy Ngonyani, a registered medical doctor working with Jhpiego, the circumcision cost in the public and private hospitals in the region varies between Sh20,000 and Sh100,000.

“I missed on undergoing circumcision at a younger age because my parents did not have the money to afford the hospital costs,” Joseph tells Your Health in an interview during a recent visit at the village.

But through the VMMC programme, Joseph who is the ninth child in a family that consists of 9 children (eight boys and two girls) has been circumcised, becoming the fifth male child in the family to be circumcised--the remaining two male children are set to be circumcised in the near future, according to Joseph’s father Anthony Abili, 55.

“Prior to the circumcision, I was not comfortable to take bath in the presence of my colleagues in the river because they used to say that uncircumcised men are dirtier. But I am no longer stigmatised,” says Joseph.

Jhpiego launched the AIDSFree Tanzania VMMC program in October 2015, in collaboration with the National AIDS Control Program (NACP), funded by USAID aimed to provide male circumcision services of which under the program the organisation has provided over 800,000 VMMCs in over 500 health facilities across the five regions: Iringa, Njombe, Tabora, Morogoro and Singida at no cost to clients.

In tandem with the program objectives, Jhpiego on July 23 launched a mobile health clinic (MHC) in a truck aimed to rapidly expand the provision of high-quality, client-centered circumcision services as a core component of comprehensive HIV prevention in Morogoro region.

The clinic serves to offer other health-related services including Tuberculosis (TB) treatment, sexually transmitted diseases (STDs) and HIV/AIDS counseling and testing and family planning education.

“The plan is to circumcise 80 per cent of men aged above 10 years old in the selected five regions,” says Dr Ngonyani.

Mgaza village where Joseph is currently living is one of the villages targeted by the VMMC programme in Morogoro region because the rates of HIV and STDs transmission are slightly high.

According to the 2016-2017 Tanzania HIV Impact Survey (THIS), HIV prevalence among adults 15 years and older in Morogoro is 4.2 per cent.

Is circumcision necessary?

The use of circumcision for medical or health reasons is an issue that continues to be debated. The medical sources indicate that the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision.

The procedure may be recommended in older boys and men to treat phimosis (the inability to retract the foreskin) or to treat an infection of the penis.

The right age

Circumcision occurs at a wide range of ages, and neonatal and child male circumcision is routinely practised in many countries for religious and cultural reasons.

According to a report titled ‘Neonatal and child male circumcision: a global review’ by World Health Organisation, there are several advantages of circumcising males at a younger versus older age, including a lower risk of complications, faster healing and a lower cost. However, some parents may wish to wait for an older age for religious or cultural reasons, or have a preference to wait until the child can give consent for the procedure.

“Although male circumcision is frequently performed in children, there is no consensus about the age at which it should be performed,” says Dr Ngonyani.

He adds, “If you were not circumcised as a baby boy, you may choose to have it done later for personal or medical reasons.” Moreover, the medical sources suggest that the necessity of circumcision varies depending on religious beliefs and social structures in society.

Benefits

Numerous studies have demonstrated that male circumcision (MC) reduces the risk of urinary tract infections, also reduces risk of some sexually transmitted diseases in men, to mention but a few.

Dr Ngonyani further reveals that the primary reasons why men choose to undergo circumcision is for protection against HIV and STDs, improved hygiene, decreased risk of penile cancer and improved sexual satisfaction with their sex partner.

“The primary reasons prompting men to choose not to be circumcised are pain during and after the procedure, long healing period, culture or religion, and time away from work,” says Dr Ngonyani.

Speaking to Your Health, Dr Zainab Chaula, the Permanent Secretary in the Ministry of Health, Community Development, Gender, Elderly and Children said, “The Government recommends male circumcision for HIV prevention. This remains an important recommendation in scaling-up MC services throughout Tanzania.”

Medical vs traditional snipping method

Medical sources indicate that male circumcision performed in a medical facility protects against HIV. There are several other important differences between traditional circumcision procedures and clinical procedures. These include differences in equipment used and counselling provided to the men before and after surgery.

Another difference is how much of the foreskin is removed. Some traditional circumcision involves only a partial removal of the foreskin, while the medical procedure removes sufficient foreskin that the glans remains fully exposed even on a non-erect penis. The sources further explain that it is not known exactly how much foreskin should be removed to reduce the risk of HIV infection in men, but complete removal seems to be the norm.

The practice of partial removal of the skin may help explain why some cultures that practise traditional circumcision still have high rates of HIV prevalence.