In a set of recommendations after the fourth annual conference on HIV research concluded on Thursday, delegates called for a ‘rapid campaign’ to sensitise the population about male circumcision before it is put to work.
Early this year, the Ministry of Health declared its intention to include circumcision as a control strategy for the HIV spread. Studies presented at the conference show that circumcision has been scientifically proven to reduce a man's risk of contracting the virus from an infected sexual partner by as much as 60 percent.
The voluntary circumcision programme is expected to start in August. Government has already lined the military to launch the exercise.
“We will use the military as role models for the rest of the population – they are adult enough to give consent, and if young men see that soldiers are willing to suffer the pain of circumcision, they will also get the courage to do it," said Dr Agnes Binagwaho, executive secretary of National AIDS commission (CNLS).
"After the military we will concentrate on students and, finally, on the general population; eventually we hope to move on to circumcising new-born babies, as long as research proves that it is advantageous and cost-effective to do so."
Unlike many other cultures in the region, Rwandan men and boys are not circumcised as a rite of passage, so it is unclear exactly how many men are circumcised but the number is presumed to be low. Research is underway to determine the percentage of men eligible for circumcision.
Meanwhile, Rwanda's Centre for Infectious Disease Control and Prevention, known as TRAC PLUS, is to conduct a 'knowledge, attitude and practice' survey in the army to determine the level of awareness-raising needed, followed by a similar survey among the general population ahead of national rollout of the programme in 2009, reports UN news service IRIN.
"The survey will ask questions like whether or not they know what circumcision is, whether they can name its advantages or disadvantages, whether they will continue to use condoms following circumcision, and so on. After that, CNLS will be responsible for information, education and communicating the message of circumcision to the public," Elévanie Nyankesha, HIV prevention coordinator of TRAC PLUS told IRIN.
"Our national public awareness campaign is due to start in July [2008] and will make it clear that circumcision cannot replace any of our existing prevention strategies – education, abstinence, faithfulness to a single sexual partner and correct and consistent use of condoms," Dr. Binagwaho told IRIN.
"People must be made aware that although circumcision is beneficial, there is still a 40 percent risk of HIV transmission, so they must know that it must be used in conjunction with another HIV prevention method, such as condom use," she said.
Vague statistics available indicate that HIV prevalence in the army is estimated at between 2% and 3% – slightly lower than the national average of three percent. Intense prevention activities have been carried out since the mid-1990s, and barracks and military hospitals are plastered with billboards and posters urging soldiers to use condoms and be tested for HIV.
"We recently interviewed 70 men at one of the army's VCT [voluntary counselling and testing] centres and, surprisingly, it turned out that 55 of them had already been circumcised either for hygiene reasons, to prevent other diseases or because they believed it would improve their sexual performance," said Dr Charles Murego, director of medical services in the Ministry of Defence.
The circumcision campaign is to be rolled out gradually over a long period, because the 35,000-strong RDF could not afford to have hundreds of men incapacitated at the same time: "We will circumcise, say, 50 soldiers per week – it would be too dangerous to carry out mass circumcision in the army."
The experts appealed for a review of the prison service in Rwanda to allow reinforcement of preventive mechanisms and treatment of HIV in prisons. Research heard shows that prevalence among inmates is raging at 6% – way above the national rate.
The conference also wants efforts intensified for availability and accessibility of preservatives, as well as behavioral changes over their use.
Faced with statistics suggesting that women are positively responding to HIV testing but without their partners, campaigners are advocating for ‘favorable environment’ to facilitate Voluntary Counseling and Testing (VCT) targeting couples.