SAM Sibanda (not real name) is a 26-year-old man living positively with HIV. He was recently circumcised but one thing is bugging him. He wants to have unprotected sex so that he gets a feel of how its like, now that he has been circumcised.
This challenge is not for Sibanda alone, but many other men who are living with the virus and have just been circumcised or are contemplating circumcision.
The Ministry of Health and Child Care in conjunction with Population Services International is carrying out Voluntary Medical Male Circumcision (VMMC) on males primarily for the purpose of reducing the chances of acquiring HIV by 60 percent. However, men who are already HIV positive are not being turned away from the procedure.
The World Health Organisation’s recommendations on VMMC state that circumcision of HIV positive individuals is generally not encouraged. However, where an individual insists that he needs to be circumcised, further counselling and assessments are done to ensure that the individual is suitable to undergo the operation and will heal within the expected time. Sibanda, like many circumcised men, wants to be able to enjoy all the “benefits” that come with circumcision.
“I have heard that having sexual intercourse with a circumcised organ feels completely different from when you are not circumcised. I want to experience that feeling too,” said Sibanda.
He added that some people have told him that a circumcised man lasts longer during sexual intercourse.
“I hear many things and I am not sure what to believe as I have not experienced it and I just want to be sure about these things,” he said.
The major challenge that Sibanda mentioned is that being HIV positive means he cannot have unprotected sex with his partner as health workers told him about the risks associated with it.
“My partner and I stopped having unprotected sex because we were told we would run the risk of re-infection. We have been having protected sex but the challenge I face is that I want to have a feel of unprotected sex now that I have been circumcised but I fear re-infection,” he said.
This is one of the challenges that are set to come up with the increased circumcision of HIV positive men if the health ministry together with PSI do not avail more information on the options that this group of men have. However, the Ministry of Health and Child Care notes that HIV positive individuals run an increased risk of passing on the virus if they resume sex before full wound healing because of the breakage of the skin and therefore if upon counselling, there is reasonable indication that the individual will not adhere to the abstinence period, circumcision may not be offered in the interest of public health. In addition, HIV positive men who undergo VMMC are not encouraged to have unprotected sex.
Dr Shingirai Makaure from Zimbabwe Community Health Intervention Research Project said HIV positive men are advised to use the Docile Slit or surgical method when they want to be circumcised as per World Health Organisation regulations.
“We encourage men who are interested in medical circumcision to use the Docile Slit method which is the surgical method. If you are HIV positive we want to ensure that we close the wound from the procedure so that healing is faster,” he said.
He said the new procedure of using a ring (Prepex) to circumcise was being preserved for HIV negative men. Dr Makure added that the health ministry was still in the process of doing a study on the effects of using the Prepex device on HIV positive men.
The non-surgical method consists of a device made of a plastic and rubber ring that stops the flow of blood to the part of the foreskin that is to be removed. After seven days the foreskin and the device are removed. Because this procedure can be performed by nurses, it means it can potentially be offered in many places.
According to Dr Makaure, the method is “more acceptable to men as it is proven to be less painful, blood-free and can be performed outside a surgical theatre” but the effects on HIV positive men are not yet clear.
Dr Makaure said HIV positive men could get circumcised for other health benefits, apart from the percieved bedroom pleasure. Some of the benefits include the prevention of penile cancer, cervical cancer in women and general hygiene as a circumcised organ is easier to keep clean than an uncircumcised one.
However, some men are still shunning VMMC saying the healing period of six weeks was rather long.
“If you get circumcised especially the surgical way you have to completely heal and this wait is rather long considering that some people are sexually active and stay with their wives. It becomes difficult to wait for six weeks,” said one man who was contemplating VMMC.
However, Mrs Patience Kunaka from the Ministry of Health and Child Care said men have to be patient as women also wait six weeks after giving birth before they are sexually active. With the options and advantages for HIV positive men who undergo VMMC still to be widely explained, the uptake is fairly low, with only six percent of people who were circumcised in 2014 being HIV positive.