Hello…..After a long time!

9 07 2011

By Edgar Asiimwe

Wow, I just realized that I have not blogged for a while! My apologies, but things have been a little intense and my access to the internet is quite sporadic out in the field. Anyways, it recently occurred to me that in my last post, I failed to mention what I’m doing in Uganda this summer…shame on me!.. So, I will get right to the point! I will be researching safe male circumcision (SMC) for HIV prevention in Uganda. My research question emanates from the results of previous epidemiological studies, including one that was conducted in Rakai, Uganda, which have demonstrated that SMC confers a 60% decreased risk of HIV infection among heterosexuals. These findings have prompted numerous stake holders, such as the WHO, to recommend that SMC be added to comprehensive HIV prevention programs in countries with high HIV prevalence but low SMC prevalence. Clearly, such policies, once instituted, could present an opportunity for several sub-Saharan African countries, with high HIV prevalence, to reduce the number of new infections. But, in order for SMC to effectively reduce HIV infections, acceptability of the procedure would have to be close to 80% (Nagelkerke & colleagues). That presents a challenging question: given this information, are un-circumcised men in these countries going to flock the surgeon’s table in droves?

Uganda is one of the countries in sub-Saharan Africa that has developed an official policy on SMC, and as such, numerous “roll out” drives have been conducted in Kayunga, Mukono, and Ntungamo. Moreover, some hospitals in Kampala offer the procedure free of charge. However, despite these initiatives, MC prevalence remains low and the procedure remains somewhat contentious with some members of the government and other key leaders offering differing positions on SMC. A recent snippet in “the red pepper” for example, Uganda’s version of “the national enquirer”, reported that President Museveni had given a speech that questioned the veracity of SMC’s ability to reduce HIV infections only to be contradicted the following day by a Bishop and a member of parliament who urged young men to go seek out the procedure.  Additionally, reputable newspapers such as “The Monitor” have published articles by some influential commentators that are both supportive of and antagonistic of SMC. These differing positions from key opinion leaders have clearly confounded young men’s willingness to undergo the procedure.However, these factors are not the only determinants of willingness to undergo SMC.  My goal this summer is to investigate how one of these determinants, educational attainment, influences personal willingness to undergo SMC in the 18-24 cohort. To achieve this task, I have been traveling to randomly selected schools in the 3 districts of Mukono, Wakiso, and Kiboga, administering surveys to students in that age range. Additionally, I have also been administering assisted surveys to young men who are out of school/ drop-outs. The vast swathe of these “out of school” young men are self -employed and work as boda-boda cyclists (one of the most popular modes of transportation), mechanics, and vendors.
Thus far, most of the respondents have been cooperative and perhaps the major obstacle to our work has been the unprecedented rainfall this season along with ferocious lightening that has claimed over 20 lives. The victims of the lightning strikes are children in rural areas who were fatally struck in the very classrooms in which they had run to seek shelter from the storms. According to nbs, one of the local news networks, the strikes were fatal because the children were bare-footed and as such, their bodies served as “conductors” for the current. Such unfortunate events are some of the daily reminders of the devastating havoc that poverty can wreak.




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