Older men too stubborn to circumcise, but driving HIV in SA
Voluntary medical male circumcision (VMMC) has many health benefits, but despite this it remains rare among older men who are among the main drivers of the HIV epidemic.
VMMC offers men many protective benefits against HIV, penile cancer, sexually transmitted infections (STIs), such as herpes as well as common urinary tract infections (UTIs). It also reduces the risk of prostate cancer – the most common cancer among South African men in their 50s and 60s.
In spite of these benefits, older men do not undergo VMMC as frequently as their younger peers. South African statistics show that VMMC uptake varies according to age with more than 60% of VMMCs being performed on men aged 10 to 19 years of age. While men older than 25, and especially 35+, access VMMC much less frequently.
Hilton Julius, VMMC Programme Manager for CareWorks – an HIV management organisation – offers an explanation.
“While younger men are increasingly seeing circumcision as a social norm, older men fear ridicule from circumcising at an older age, since its culturally considered most appropriate before adolescence. Another barrier is that their perceived risk of contracting HIV and other STIs is lower because of their age and that they’re in a ‘protective’ marriage or partnership. Concerns about the post-surgical abstinence period of six weeks have also led to low uptake among older men.
“Furthermore, older men are in part to blame for SA’s high HIV infection rate among young women. The findings of a study, which was released last year by the Centre for the AIDS Programme of Research in SA (CAPRISA), confirmed that the cycle of HIV transmission was driven by high rates of new HIV infections in adolescent girls from older men. Many of these men were also partners of similarly aged women who have HIV prevalence rates exceeding 60%, which sets in motion a deadly cycle,” remarks Julius.
Each year, about 380 000 new HIV infections occur in adolescent girls and young women aged 16 to 24 years in southern and eastern Africa.
Julius highlights that this age–sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates as the girls do not feel they can negotiate condom use and many of these older men are not medically circumcised.
“Limiting HIV infections by getting older men to circumcise is key in attaining epidemic control and cannot be overlooked. VMMC has been proven to reduce a man’s lifetime risk of HIV by up to 60%, and will in the long term have a substantial effect on reducing new HIV infections primarily in men, but by association in women as well.
“The health benefits of medical male circumcision far outweigh the risks. Older men should seriously reconsider their reasons for not wanting to circumcise, since there is ample clinical evidence which points to its medical benefits. Most women should support VMMC, especially since it reduces their risk of acquiring the human papilloma virus, which is responsible for most cervical cancer cases.
“Targeted HIV prevention interventions such as VMMC can break the cycle of HIV transmission and impact the course of HIV in South Africa for the better. I would like to encourage older men to adopt the practice of male circumcision and in so doing, to serve as role models for younger men,” says Julius.
To protect yourself and your family, book a free circumcision by SMSing your full name to 35255 and a trained VMMC counsellor will call you back.