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Creating a New Norm in Non-Circumcising Ethiopian Province

GAMBELLA, Ethiopia, Nov 25 2013 (IPS) - Chiang Both from Gambella, a remote and a traditionally non-circumcising province in Ethiopia that borders Sudan, volunteered to undergo the procedure despite his community’s initial mistrust.  

Ethiopia has one of the highest circumcised male populations in Africa – 93 percent, according to a 2005 survey by the Ethiopia Demographic and Health Survey. But the dominant ethnic groups of the Nuer and the Anuak in Gambella have until recently regarded the procedure with suspicion and as an instrument of “imperious foreigners”, disliked because of their historic attempts to change the Nuer culture. They also feared that it could cause impotency.

“The people in our culture are in doubt and believe that others want to change our culture. But those of us who have thought about the benefits, see it as only positive,” Both told IPS, explaining that hygiene and HIV prevention were two important benefits of circumcision.

Kelly Curran, director of HIV/AIDS and Infectious Diseases at international health non-profit, Jhpiego, told IPS: “The vast majority of men in Ethiopia are circumcised for religious or cultural reasons, usually in infancy. Gambella region is the exception.”

However, attitudes in the region are changing. It started in 2009 with a voluntary medical male circumcision (VMMC) campaign, which set out to increase circumcision prevalence to 80 percent by circumcising more than 40,000 men.

“When the VMMC programme started, Gambella was the only region in Ethiopia where less than half the men were circumcised, and it had an HIV prevalence three times the national average,” Curran said. Gambella has an HIV prevalence rate of 6.5 percent and a male circumcision rate of only 46.8 percent.

Randomised controlled medical trials in Kenya, Uganda and South Africa carried out by the French National Agency for AIDS Research and the United States National Institutes of Health successfully demonstrated that VMMC reduces the risk of female-to-male sexual HIV transmission by roughly 60 percent.

Based on the success of the trials, in 2007 the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation identified 13 countries with high HIV prevalence and low circumcision rates, all of which were in East and Southern Africa.

There are now 14 countries implementing VMMC programmes, in which males receive a package of HIV prevention services including education and risk-reduction counselling, HIV testing, screening for sexually transmitted infections and condoms.

HIV transmission in Gambella is high due to a low level of awareness, a high influx of itinerant farm workers, and a high number of refugees from neighbouring South Sudan said Ajim Othow, the Gambella regional HIV/AIDS prevention and control officer.

“HIV awareness is low especially among the local population. Many still believe that condoms carry viruses. They understand that HIV exists, but do not take it seriously,” Ajim told IPS.

In 2009, Jhpiego, with support from the U.S. Centres for Disease Control and Prevention, partnered with the Gambella regional health bureau to target adult males here. Gambella had only one surgeon prior to the medical alliance.

To date, the programme has circumcised over 32,000 males, trained 71 healthcare providers as male circumcision surgeons, and trained 26 educators and counsellors as well as 129 health extension workers.

“This programme is really trying to create a new norm in Gambella, it also has worked hard to respect the diverse ethnic groups living in Gambella,” said Curran.

VMMC is cost effective as it saves on antiretroviral therapy costs, which are expected to exceed 5.8 million dollars between 2009 and 2025 in Ethiopia. Modelling shows that every five to 15 circumcisions avert one HIV infection in a high HIV-prevalence environment.

In Gambella town, outreach campaigns have targeted at-risk populations such as high school students and the city’s prison population. The programme has also sponsored educational broadcasts in the local ethnic language on local radio. All of which have helped to raise awareness of the benefits of male circumcision.

Bang Chut, a 32-year-old water supply worker, attended the programme’s Lare health centre in Gambella with his wife. On the basis of an educational campaign, they both decided he should take advantage of the free surgery and be circumcised.

“We read the leaflet together. It was written in our language and easy to understand. We both see the obvious benefits. Now that it’s free, there’s no reason not to do it,” he told IPS.

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  • Jhon Murdock

    HIV enters through the urethra not through the foreskin which protects the penis and the urethra. The mechanism by which HIV enters the foreskin has never been demonstrated, only alleged. Why did the good doctors never stop to examine the urethra which is an OBVIOUS place to begin looking? Why all the emphasis on cutting instead? Why are those who are in back of the grand African circumcision experiment keeping so quiet about the following study?

  • TLCTugger

    Most of the US men who have died of AIDS were circumcised at birth. Wawer/Gray showed in Uganda in 2009 that cutting HIV+ men made them MORE likely to infect female partners.

  • Hugh7

    In 10 out of 18 countries for which USAID has figures, more of the circumcised men have HIV than the non-circumcised. Ethiopia is one of the other 8, but by insignificantly little. Don’t expect the great cost of circumcising all those men to have any effect on the HIV rate at all – except that it will give circumcised men a false sense of security, and they will fling caution – and condoms – to the wind, and the rate will rise.

  • gary

    When are Africans going to wake up and figure out that circumcision is a fraud and a racket perpetrated by quacks that renders the victim sub-normalized for life.

  • d5810

    This is a great tragedy in the making. The stories are rolling in about circumcised African men refusing to wear condoms because they think they have been given a “surgical vaccine” or because they now have a “natural condom”. This, combined with increasing desensitization due to the effect of circumcision (leading to even more reluctance to wear a condom) will unfortunately result in an increasingly unprotected population with tragic results. One only need to look at countries that do not routinely circumcise (most of Europe) and their respective HIV and STD rates, to see how wrongheaded and downright cruel this African venture is. I am sure that these men are not giving truly “informed” consent. They are not told what they are losing. FOR SHAME!!!

  • Vestias

    Há que encontrar uma nova estratégica de politicas onde toda a população tenha o direito a ter acesso aos sistemas sociais da Etiópia iniciativas onde todos possam ter as mesmas oportunidades

  • SteveB954

    If a man still has to use a condom for protection from HIV, why cut off a part of his penis that provides pleasure for himself and his partner?

    “The penile foreskin is a natural and integral part of the normal male genitalia. The foreskin has a number of important protective and sexual functions. It protects the penile glans against trauma and contributes to the natural functioning of the penis during sexual activity. Ancient historic accounts and recent scientific evidence leave little doubt that during sexual activity the foreskin is a functional and highly sensitive, erogenous structure, capable of providing pleasure to its owner and his potential partners.” ~ Statement on Non-therapeutic Circumcision of Boys, Nordic Association for Clinical Sexology

  • minorityview

    Many professionals have criticized the studies claiming that circumcision
    reduces HIV transmission. They have various flaws. The investigators did not
    seek to determine the source of the HIV infections during their studies. They
    assumed all infections were heterosexually transmitted. Most HIV infections in
    Africa are transmitted by contaminated injections and surgical procedures. The
    absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%.
    Authorities that cite the studies have other agendas including political and
    financial. Research shows that circumcision causes physical, sexual, and
    psychological harm. This harm is ignored by circumcision advocates. Other
    methods to prevent HIV transmission (e.g., condoms and sterilizing medical
    instruments) are much more effective, much cheaper, and much less invasive.
    Please see
    for more information and links to literature.

  • AngelXY

    Yep the plunder of Africa continues. So now they are hijacking the tradition and simply diverting the money into the wallets of those selling surgical kits, circumcision devices and pills. Renaming and re-branding circumcision as a “medical procedure” the same way they did in America for profit. Genital cutting – American style, Now selling in Africa! What a joke!

  • Eric Taylor

    really sounds ridiculous when you think about it because HIV is spread through semen and bodily fluids not foreskin

david farrell krell