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Aids blow on circumcision ritual By Paul Udoto Male circumcision is opening new frontiers in Aids prevention. When Aids emerged two decades ago, nobody imagined it would turn into a health, security, development, and cultural issue. Now researchers are debating the relationship between male circumcision and HIV-Aids prevention. But for the Bukusu in Bungoma District and Diaspora, a practice the community clings on is potentially a source of blood-related infections. The teachings given to initiates have a bearing on sexual behaviour after graduating into manhood. The advent of HIV/Aids seems to have lit a fuse under the practice.

Sirisia MP John Munyasia, whose clansman Mango Omukhurarawa is believed to have restored the rite, has been meeting traditional surgeons to review the counselling messages and ensure hygiene.

The executive director of Bungoma Healthcare Consortium, Dr George Masafu, says at least 10,000 boys will face lukembe- the knife - this season. Significantly, over 20,000 animals will be slaughtered in festivities associated with the embalu rite.

Since early 1920s when Quaker missionaries set shop in Kaimosi, Christian converts have been drifting to hospital for the cut.

For long, the hospital initiates have been derided for cowardice. The growing disquiet over risks in home circumcisions has provoked a chief in Kimilili to ‘ban’ the traditional cuts.

But the HIV/Aids fast spread has put the waning traditional circumcision on the spot.

“It is important to report that high risk behaviour may wipe out the benefits conferred by circumcision,” says a report by the National Aids STD Control Programme (Nascop).

Apart from the medical risks of infection from unsterilised knives, the messages conveyed to initiates during khubita (blessing and counselling) have an important role in the initiates’ sexual behaviour.

Beyond the routine sexually allusive “open door-closed door” message, little mention is made of such youth-related issues as drug abuse, teenage pregnancies, school drop out, and chastity.

With no more cattle raids, the messages have become irrelevant in the face of competition for educational and employment opportunities.

For Ibrahim Opilo, a retired teacher, many who purport to adhere to the traditional ceremony are ignorant about why certain things are done. He cites the muddying, ututu grass, kumusuni and etiang’i as confusing practices.

Most of those who go to hospitals are Christians who associate the traditional ceremony with indecent songs and dancing, immorality, ancestor worship, and high feasting expenses. Others fear bewitching and the shame of crying by initiates from the circumcision pain. To reduce chances of infection, the Ministry of Health and the provincial administration have been conducting workshops for traditional surgeons to educate them on HIV/Aids.The vice-chairman of the Kenya Medical Association, Dr Wekesa Buteyo, suggests that every traditional surgeon should have at least 20 disposable knives. He says doctors and other health officials will be accompanying the traditional practitioners.

There is no research showing figures of circumcision-related HIV infections. Given the long window period the virus takes to be identified, the infections will only be realised a decade after circumcision.

Hordes of parents are opting for the hospital cut to minimise costs and ensure safety. The official cost sharing rates for each operation range between Sh 50 in health centres to Sh 150 at district hospitals.

However, the Bungoma District Medical Officer of Health, Dr Allan Gohole, concedes that there are extra payments made because of the cultural aspects.

“Besides rams, it would require a doctor to stand behind every circumcisor to ensure recommended rates,” he says.

He says Government hospitals ensure affordability and health safety. The initiates’ wounds are treated like other wounds apart from the anti-tetanus jabs for initiates above five years.

The Sessional Paper No 4 on HIV/Aids in Kenya notes that different communities’ cultural and religious stands on such issues as sex and marriage, have a bearing on the management of Aids.

The Nascop report suggests that male circumcision could be added to a battery of interventions in the HIV preven- tion. But it adds that like female circumcision, such efforts meet resistance from communities steeped in traditions.

A report released by the Joint United Nations Programme on HIV/Aids, says a study of over 6,800 men in rural Uganda has suggested that the timing of circumcision is important: HIV infection was found in 16 per cent of men who were circumcised after the age of 21 and in only seven per cent of those circumcised before puberty.

The Unaids report says many societies confer on their young ideals that are not always matched by reality.

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