BUGESERA - In Rwanda, circumcision has become trendy.

More and more young men have begun to have the procedure performed to limit the risks of HIV infection. The Ministry of Health launched its free male circumcision program in 2011, with a goal of medically circumcising 50% of men in two years as part of its HIV/AIDS prevention program.

Unfortunately there have been two drawbacks to this program. First, there is so much demand, that the Ministry of Health has been overwhelmed. In Rwanda, there are only two doctors for every 100,000 people. Second, it’s becoming apparent that many men do not know that being circumcised may only limit, not eliminate the risk, of being infected.

Prompted by the health and sex-related campaign, circumcision has also taken on a social appeal and status symbol. “We are always on the look-out, listening to the radio so we don’t miss announcements from the Rilima district board about the next circumcision campaign," says Kamanzi, a student from the Rilima school, in the eastern Rwandese town of Bugesera.

Since the operation is now free and performed by qualified government staff, there are so many candidates that demand can’t be met. "Some are going to neighboring provinces,” notes François Mutijima, another student.

Reducing risks

According to Gaspard Gasirabo, a health ministry representative for the Rilima district, workers from the ministry usually come on Thursdays, which is market day in the town. They try to convince teenagers and men to get circumcised by explaining how safe and simple the operation is.

Studies from the World Health Organization and UNAIDS have shown that circumcision can reduce the risk of HIV infection by more than half. Circumcision could prevent two million contaminations and 300,000 deaths over the next ten years in Sub-Saharan Africa.

“This active campaign has raised awareness among teenagers and young men. They are constantly asking me when the medical staff is coming back so that they can get circumcised for free,” explains Gaspard. Until then, they had to pay for the operation, and many went to traditional healers who performed it without respecting hygiene and safety standards.

However this newfound enthusiasm is also very risky, as it often results from a misinterpretation of the prevention message. Many teenagers and men wrongly believe that once they have the procedure, they do not need to wear a condom to protect themselves from HIV. Prevention is therefore still necessary to avoid sexually transmitted diseases, among men and women alike, as women can be infected by circumcised men.

How circumcision creates discrimination

Among young people, circumcision has actually become “fashionable.” Thanks to the Internet and television, they learned that in neighboring countries like the Democratic Republic of Congo and Uganda, circumcision was often a tradition, and not only for Muslims. For these young people, circumcision has become a sign of cleanliness.

And for those who do not follow fashion, life can become complicated. “I decided to pay 50,000 Rwanda Francs ($80) to get circumcised. I couldn’t stand being insulted by other students anymore. They called me a good-for-nothing, a kafiri (‘uncircumcised’) or a bottleneck (referring to a non-circumcised male organ),” says François.

Three of his friends also admit they went through a similar experience. “Rwandese society still accepts uncircumcised men, but in some districts, they are sometimes frowned upon. And it’s even worse in high school, where they are discriminated against,” reveals Gaspard.

Among girls and women, circumcised men have also gained some prestige lately, in a country where the custom was not very common until now. Mrs Kanyange, a mother of three, thinks that despite its cost, circumcision has great advantages: “It ensures cleanliness, and the operation is also an esthetic one for men.”

For these reasons, men would like circumcision to be covered by their health insurance. Andrew Makaka, former National Health Insurance director, is more cautious on this issue: “Circumcision is a prevention surgery, and therefore it is not included in Health Insurance schemes. It would all the more difficult since the latest census reveals that more than 1.5 million men wish to get circumcised...”