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Even though these problems only occur in about 10% of men, they can be very painful if not treated. Costs vary from provider to provider, but one only needs approximate figures to make the point. Costs are much lower in developing countries, but the same principle applies: adult circumcision is more expensive than infant circumcision. A year later, of the 1,252 men who returned for interview, only 111 (8.9 %) had been circumcised in the interim despite it being offered for free, or heavily subsidised. The South African Medical Association (SAMA) began making infant circumcision available in Kwa Zulu-Natal as long ago as 2011, much to the consternation of intactivists.

In older males, phimosis can cause urine blockage leading to kidney damage. For example, in Rwanda, an infant circumcision costs about , an adult one , and the procedure is hugely cost-saving in a country with 3 % HIV prevalence (low by African standards) (Binagwaho . In resource-limited settings this is very important. Doubtless many of those men will have got circumcised eventually, after the studies concluded, but there is still a marked shortfall between numbers saying they are willing, and numbers actually getting it done. That infant circumcision is the way to go long term is now consensus amongst the bodies dealing with the epidemic.

They are the “C” in the “ABC” approach: Abstinence, Be faithful, Condoms. In some instances the problems have been practical. One of the deterrents, or barriers, is the need to abstain from sex during healing. M., Taruberekera, N., Mugurungi, O., Ahanda, K., Njeuhmeli, E. id=10.1371/0085051 Herman-Roloff, A., Otieno, N., Agot, K., Ndinya-Achola, J., Bailey, R. (2011) Acceptability of medical male circumcision among uncircumcised men in Kenya one year after the launch of the national male circumcision program. There is a window of opportunity in early infancy when circumcision is safest. (2012) A ‘snip’ in time: what is the best age to circumcise? On-line: https://gov/pmc/articles/PMC3359221/ Morris, B. Accordingly, any suggestion of cutting such a psychologically, as well as physically, “sensitive” region will likely result in an instinctive rejection. F., (eds.) Genital cutting: protecting children from medical, cultural, and religious infringements. (2016), Bringing early infant male circumcision information home to the family: Demographic characteristics and perspectives of clients in a pilot project in Tanzania. On-line: https://gov/pmc/articles/PMC4944577/ Hines, J.

People living in remote rural communities may be a long walk away from the nearest supply, but they only have to access a mobile circumcision clinic once and they are (partially) protected for life. Six weeks is the recommended time, eight if a suture-free device (such as Prepex) is being used. (2014) Barriers and motivators to voluntary medical male circumcision uptake among different age groups of men in Zimbabwe: Results from a mixed methods study. After that time, the baby enters a phase called mini-puberty. But two things can counter that: familiarity and education. 29-31July 2010, University of California – Berkeley.

The new draft guidelines mirror an updated policy on circumcision released by the American Academy of Pediatrics in 2012. On-line: https://gov/pmc/articles/PMC1082801/ The idea behind this common assertion is an implication that men value their foreskins so highly that few would wish to part with theirs’, or that if infants could express a wish they’d say, “No”. The statement is also false, as is so often the case with intactivist claims.

These measures have been ongoing for the past few years and have shown many positive effects already. (2006) Acceptability of male circumcision for prevention of HIV infection in Malawi. On-line abstract: https://gov/pubmed/16736112 Plotkin, M., Castor, D., Mziray, H., Küver, J., Mpuya, E., Luvanda, P. ” Social and individual factors affecting adult attendance at voluntary medical male circumcision services in Tanzania. On-line: https://gov/pmc/articles/PMC4168557/ Skolnik, L., Tsui, S., Ashengo, T. (2014) A cross-sectional study describing motivations and barriers to voluntary medical male circumcision in Lesotho. On-line: https://gov/pmc/articles/PMC4287583/ Ssesekubugu, R., Leontsini, E., Wawer, M. E., Nalugoda, F., Sekamwa, R., Wagman, J., Gray, R. (2013) Contextual barriers and motivators to adult male medical circumcision in Rakai, Uganda. On-line abstract: https://gov/pubmed/23515302 Toefy, Y., Skinner, D., Thomsen, S. (2015) “What do You Mean I’ve Got to Wait for Six Weeks?! To understand why, we must first look at what puts people off circumcision in adulthood. prices are similar, only in £s, as a search of clinics offering the procedure will show. (2006) Acceptability of male circumcision for prevention of HIV infection in Malawi. On-line abstract: https://gov/pubmed/16736112 Njeuhmeli, E. (2014) Cost and Impact of Scaling Up EIMC in Southern and Eastern Africa using the DMPPT 2.0 Model. But being accepting of circumcision does not necessarily translate into getting it done. S., Qin, B., Upur, H., Zhong, C., Ye, L., Liang, H. E., Chituwo, O., Mumba, M., Xaba, S., Mandisarisa, J., Baack, B. K., Ncube, G., Mugurungi, O., Ticklay, I., Cowan, F. (2016) Comparative cost of early infant male circumcision by nurse-midwives and doctors in Zimbabwe. On-line: https://gov/pmc/articles/PMC4944581/ Ministry of Health (2012) Country operational plan for the scale-up of voluntary medical male circumcision in Zambia, 2012 – 2015. On-line: https:// (2015) National Emergency Response Council on HIV and AIDS (NERCHA). (2014) Cost and impact of scaling up EIMC in Southern and Eastern Africa using the DMPPT 2.0 model.

These ongoing efforts to spread circumcision in developing nations in order to curb the spread of HIV are a triumph of common sense, global health initiatives, science, and basic humanity. Circumcision also eliminates problems like phimosis (non-retractable foreskin) and balanitis (inflammation of the foreskin). J., Hellar, A., Curran, K., Lukobo-Durell, M., Ashengo, T. ” Understanding the sexual behaviour of men and their female partners after voluntary medical male circumcision in the Western Cape. On-line: https://gov/pmc/articles/PMC4503729/ Wawer, M. J., Makumbi, F., Kigozi, G., Serwadda, D., Watya, S., Nalugoda, F., Buwembo, D., Ssempijja, V., Kiwanuka, N., Moulton, L. By waiting until the male is old enough to decide for himself if he wishes to be circumcised or not, one is in effect waiting until he cannot afford it. an infant circumcision costs around 0 – 0, an adult one about 0 – ,000 depending on medical factors, and type of anaesthesia ( Essentially, in developed countries an adult circumcision can cost up to about ten times an infant one. In that second study, 1,634 Malawian men were recruited. (2012) Factors associated with uptake of infant male circumcision for HIV prevention in Western Kenya. On-line abstract: https://gov/pubmed/22711723 Zamawe, C. (2017) Impact of educational interventions on acceptance and uptake of male circumcision in the general population of Western China: A multicenter cohort study. On-line: https://gov/pmc/articles/PMC5668315/ This statement (from ) and variants of it (e.g. It is true in most counties, but in high HIV settings circumcision, including of minors, is being promoted by the WHO, CDC, UNAIDS, and PEPFAR, with support from UNICEF, the Bill & Melinda Gates Foundation, and various local government and health bodies. The extended national multisectoral HIV and AIDS framework (e NSF) 2014–2018. On-line: https:// WHO & UNAIDS (2011) Joint strategic action framework to accelerate the scale-up of voluntary medical male circumcision for HIV prevention in Eastern and Southern Africa, 2012 – 2016.

Often the only permanent treatment is circumcision. (2013) Dramatic increases in HIV prevalence after scale-up of antiretroviral treatment: a longitudinal population-based HIV surveillance study in rural kwazulu-natal. The idea is that because infants and children are not sexually active they do not need circumcision. Intended as a reason to wait until adulthood if circumcision is proposed as prevention for sexually transmitted infections (STIs) in general or HIV in particular, this argument, when looked at rationally, actually backfires rather badly on the intactivists. He may incur travelling expenses getting to the clinic, and he will have to take time off work while he recovers. With no culture of circumcision, men are simply unfamiliar with it. (2013) Acceptability and uptake of neonatal male circumcision in Lusaka, Zambia. On-line abstract: https://gov/pubmed/22968397 Westercamp, M., Agot, K. (2015) Parental factors affecting the circumcision of non-Muslim Chinese boys include education and family history. (2012) Factors influencing Chinese male’s willingness to undergo circumcision: A cross-sectional study in Western China. On-line: https://gov/pmc/articles/PMC3257276/ You Gov (2015) Circumcision survey. For high-HIV settings the following sources give more information: CDC advocates “., 2016). (SAMA) introduced infant circumcision in Kwa Zulu-Natal in 2011 it caused consternation amongst intactivists, who responded by misrepresenting SAMA.

A summary of a risk-benefit analysis of circumcision can be found in the flyer circ-risk-benefits Intactivists react to this overwhelming body of medical evidence the only way pseudoscientists can – with a seemingly endless parade of misleading, half-true, or even downright bogus arguments. The problem with behavioural approaches is that they depend on a lifetime of diligent compliance. Achieving high circumcision rates is vital in HIV epidemic settings. A few hardy souls may return promptly, but in doing so they risk injury, such as the wound opening up. It is something foreign, that religious groups do, and not for them. SOUTH AFRICA: PEPFAR recommends infant circumcision: (Njeuhmeli, 2014). The story is told here: and here: A further attack is here: which was rebutted here: SWAZILAND set a target of 50 % infant circumcision by 2018: (NERCHA, 2015).

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