LUSAKA, ZAMBIA – When Danny Lungu, 50, was growing up, his parents told him he had been circumcised as a baby because of a medical condition, he says. He thought being circumcised meant he could never get a sexually transmitted disease.
Lungu based his rationale on false information from friends and his parents, he says. That belief motivated him to engage in unprotected sex with multiple women, which led him to contract HIV in 1990 at age 27.
“Even after testing HIV-positive,” he says, “I continued womanizing because, for me, it was impossible that I was positive.”
Lungu did not take his diagnosis seriously until the late 1990s, when his health started failing and his wife and child died of HIV-related illnesses, he says.
Now, the ever-cheerful Lungu is an HIV and AIDS activist who aims to prevent other men from basing their sexual habits off the same myth. Many men in Zambia believe that once they are circumcised, they become immune to HIV, he says.
Lungu, who works as a counselor and waiter at Chainama Hills College Hospital of Health Sciences, recounts an incident in which he went to talk to people about HIV-related issues at the nearby Chainama Hills College Hospital, located east of Lusaka, the nation’s capital. Upon walking into a male circumcision ward, a queue of young men greeted him and said they wanted their foreskins cut, he says.
When he asked the anxious-looking young men why they wanted to be circumcised, they responded that they wanted to avoid contracting HIV, he says. This gave him a platform to share his story with them in the hopes of raising awareness that circumcision does not make men immune to HIV.
There is a lot of misunderstanding about HIV transmission in Zambia because of an inadequate emphasis on condom use in popular advertisements for a governmental campaign, Lungu says. The campaign promotes circumcision as a strategy to reduce new infections.
Community members charge that popular advertisements for the government’s male circumcision campaign to reduce new HIV cases may actually increase the risk of transmission because they do not mention condom use, leading men to believe circumcision alone will protect them from HIV. The government does offer counseling promoting condoms at the time of circumcision, but men’s health advocates worry that men will forget the message if they do not hear it often or never hear it if they are circumcised as infants. Government officials say partner organizations promote various strategies in the multipronged campaign, but the national parliament will consider the necessity of increased condom awareness.
The male circumcision campaign is a Zambian government program under the Ministry of Community Development, Mother and Child Health. The campaign goal is to reduce the high prevalence of HIV and AIDS, which stood at 12 to 14 percent of adults between ages 15 and 49 in 2012, according to a UNAIDS country profile.
Circumcision can reduce the risk of HIV infection by approximately 60 percent for heterosexual men, according to the World Health Organization.
Only 13 percent of Zambian men are circumcised, according to a 2012 Ministry of Health report. It cites the low circumcision rate among the primary drivers of new HIV infections.
To respond to the problem, the Ministry of Health began the National Male Circumcision Programme in July 2009 as part of its larger HIV-prevention program. The male circumcision program now operates under the Ministry of Community Development, Mother and Child Health.
The ministry’s target is to circumcise an estimated 1.9 million men and boys by 2015. It plans to reach this target through infant circumcision as well as voluntary adult circumcision with the help of partner organizations, such as the Planned Parenthood Association of Zambia.
Since 2007, slightly more than 170,000 male circumcisions have been performed each year in Zambia, according to a 2012 report from The Global Fund to Fight AIDS, Tuberculosis and Malaria, an international financing institution.
As part of the government’s campaign, it produces advertisements promoting circumcision that run on the Zambia National Broadcasting Corporation state television station and radio stations as well as on private radio stations. One of the most popular of these advertisements stars a prominent member of Zambia’s National Assembly, and another features female actors who encourage their partners to get circumcised in order to prevent HIV transmission. Neither mentions condom use.
Although Lungu supports male circumcision, the government’s messages about HIV prevention do not tell the whole story, he says.
“The approach of adverts are misleading,” Lungu says. “Even the adverts on televisions, there is no mention of condom use. It just says, ‘Go for male circumcision to have partial protection against HIV.’ And most of the young men that go for circumcision take it they are protected from HIV infection.”
Although counseling that encourages condom use accompanies all male circumcisions performed through the government’s program, the campaign must repeat the message over the airwaves to ensure victory in the fight against HIV, Lungu says.
“Yes, the counseling is there, but how sure are we that condom use is emphasized before the surgery?” Lungu asks. “And what about those that are circumcised as babies? Where will they get the information on condom use as they are growing up if the adverts do not provide that?”
Moses Mwenya, a taxi driver in Lusaka who is not circumcised, shares Lungu’s concerns.
“I get worried that we are actually not winning the fight on HIV when I hear and see how careless some of my circumcised friends behave,” he says. “I may not even go for circumcision because it might just encourage me to forget the condom.”
A lot of teaching is still necessary about both circumcision and condom use, and the current set of advertisements is inadequate to protect people from HIV and sexually transmitted infections, he says.
“These adverts running merely mention partial protection on HIV and STIs,” he says. “[They] are not doing us any good. Emphasis must be placed on both circumcision and condom use.”
Mulunda Muuka is a counselor at a partner in the government’s male circumcision campaign, the Planned Parenthood Association of Zambia, a member association of the International Planned Parenthood Federation, which provides and advocates for sexual and reproductive health and rights. When men arrive for circumcision with the belief that it will protect them from HIV, it is a challenge to convince them otherwise, he says.
The pre- and post-circumcision counseling he practices emphasizes condom use, as does the counseling at all health centers affiliated with the government’s program, Muuka says. But in the absence of a large-scale public health campaign to remind circumcised men to use condoms consistently, they tend to forget and engage in unsafe sex.
“These men that are circumcised need to be constantly reminded of condom use, although that is done during counseling,” he says. “But they forget because there is no information to remind them.”
Continuing public service reminders would be the best way to change his clients’ minds, Muuka says.
“We have clients that believe that once they are circumcised, they can never get HIV,” he says. “And these are people who need to be constantly reminded on the use of condoms.”
Women’s involvement in the campaign for circumcision and HIV prevention can also help achieve the intended target, he says.
“Behind most men that come for circumcision, there are women that have persuaded them to go for circumcision,” he says.
Caroline Banda, a marketer at Soweto Market, the largest in Lusaka, says she would like her husband to get circumcised. But she worries that the myth that circumcision makes men immune to HIV may cause him to cheat on her, which could leave her susceptible to the virus.
“I would love my partner to get circumcised because it will benefit me,” she says. “But on the other hand, if he does not understand that he needs to have protected sex at all times, his circumcision might just harm me, because he would go about having unprotected sex, and in the end, we all get infected.”
Dr. Joseph Katema, the minister of community development, mother and child health, became irritated when responding to local assertions that the government is not doing enough or promoting the right approaches.
Many partners assist the government in its campaign against HIV, including religious organizations that prefer to promote abstinence instead of safe sex, he says. The government welcomes help from its many partners that have different ideologies.
“First and foremost, I would like to inform you that the fight against HIV and AIDS is [a] multifaceted, multisectored intervention,” Katema says. “We have the whole array of interventions put together.”
One approach is not better than another, he says. If one partner group did not want to promote condoms because of a belief in abstinence, he would still welcome its assistance.
“If this organization is promoting circumcision, do we stop them because they are not promoting condom use?” he asks. “We do not expect all our partners to talk about the same thing. [Some] are preaching abstinence, others are preaching discussion, while others are preaching condom use.”
Although Katema values the church’s position on abstinence, young people still engage in premarital sex and should receive guidance to use condoms, as Planned Parenthood offers through its counseling, he says. He urges other campaign partners with similar ideologies to also encourage the use of condoms.
“If there is anybody advocating the use of condom,” he says, “please assist in propagating that information.”
Vincent Mwale, a member of parliament for Chipangali, a constituency in the Eastern province, is the spokesman in a popular government television advertisement for circumcision as part of the campaign.
In the advertisement, he states, “Male circumcision gives partial protection from HIV, provides good hygiene and prevents cervical cancer in women.” But he does not mention condoms.
The advertisements provide clear information, he says.
“I disagree to say the information in the adverts is misleading,” Mwale says. “It is made clear that circumcision just reduces the chances of HIV infection and other STIs.”
The messages about circumcision do not mention condom use because the target is to encourage men to get circumcised, he says. Counseling will take care of the rest.
“The adverts are specifically targeted at encouraging people to go for circumcision,” he says. “We are not combining messages because each client that goes for circumcision [has] counseling done on how they should protect themselves.”
But maybe members of parliament should consider advertisements mentioning condoms, Mwale says. He plans to raise the matter in the National Assembly if it proves true that the counseling is insufficient to raise awareness of condom use for circumcised men.
“Maybe the counseling is not enough,” he says. “That is a challenge we need to look at.”
GPJ translated one interview from Nyanja.
