Thursday, September 11, 2014

LEICESTER, UK: Psychiatrist may be struck off for unauthorised circumcisions

Leicester Mercury
September 9, 2014

Psychiatrist faces being struck off for carrying out unregulated circumcisions

A doctor circumcised dozens of young boys in a filthy clinic on the first floor of a terraced house, a tribunal heard.

Dr Hassan Ramadan Abdulla, 63, was not registered by the Care Quality Commission when he undertook the procedures for religious or traditional reasons at his Leicester clinic.

The NHS psychiatrist, who is also a member of the Royal College of Surgeons, charged parents £70 to circumcise boys at his private Al-Khalill Clinic, in the Evington area, from 2002.

He admitted six offences of carrying out surgical circumcisions over a three-and-a-half month period in 2011 without the registration required by law at Leicester Magistrates Court in July last year.

Five of the offences related to carrying out operations on individual boys, while the sixth related to illegal surgery performed on a further 36 children.

Dr Abdulla, of Sudbrook, Lincoln, was fined £2,700 and ordered to pay more than £30,000 in costs.
He is now facing a Medical Practitioners Tribunal Service fitness to practise hearing in Manchester, where he could face a ban from the profession.

Nigel Grundy, for the General Medical Council, said: "This case concerns, not Dr Abdulla's NHS practice as a psychiatrist, but his operation of the private clinic to perform circumcisions on male babies and young children for religious or traditional reasons."

He told the panel that the clinic operated, on Saturdays, from the first floor of a 1920s or 1930s terraced house.

Dr Abdulla has admitted that the premises were inadequate and that he did not maintain clean or sterile instruments.
...

KENYA: Amnesty for female genital cutter after girl's death

News24 (Kenya)
September 4, 2014

Female circumcision killer gets amnesty despite girl's death

Nairobi - A woman who carried out female genital mutilation on a 16-year-old girl who then bled to death has been given an amnesty after agreeing to stop the practice, police said Thursday.

"We have extended an amnesty to her because she came out and owned up," said Charles Wasike, the police chief in West Pokot county, situated on the border with Uganda.

"She is an example to others, and we encourage similar people to come out and own up," he told AFP.
Kenya outlawed FGM in 2011, with practitioners punishable by a minimum three-year jail term or fine, and life imprisonment if the procedure causes death.

The Standard newspaper said the woman, Cheponger Yarasia, admitted to police that the girl's parents had sought her out to perform the ritual because their daughter was pregnant, and that giving birth before undergoing FGM was considered taboo.

The report said the procedure went wrong and the girl bled to death.

FGM, which affects tens of millions of women particularly in the Horn of Africa and East Africa, ranges from removal of the clitoris to the mutilation and removal of other female genitalia.

Teresa Lokichu, an anti-FGM campaigner, said the girl's parents had refused to take her to hospital in order to conceal the ordeal.

"The young girl died a month ago, but the woman who circumcised her came out two weeks ago," Lokichu said, explaining that she had marshalled the help of local church leaders to get the woman to come clean, go to the police and sign a promise not to do it again.

"It's a rampant practice among many nomadic communities in the region," she said.

Local media reported that the woman said she would circumcise 50 girls per day during holiday seasons, and charged between three and five US dollars for the procedure.

UGANDA: Prostitutes take more risks with cut men

The Observer (Kampala)
September 2, 2014

Uganda: Circumcision Promoting Risky Behaviour - Report

by Racheal Ninsiima
A new study of 314 female sex workers (FSWs) in Makindye division found that more than half of respondents falsely believe that once a man is circumcised, protection is not necessary during sex.

The International Health Sciences University (IHSU) study was titled: "Understanding the dynamics and practices of female sex workers with both circumcised and uncircumcised men in Makindye division."

It was done in the Kampala suburbs of Kabalagala, Kansanga, Makindye II, Kibuye, Katwe, and Ggaba, between July and August 2013. Although there is no significant difference in sexual practices between circumcised and uncircumcised men, there is a misconception about the advantages of male circumcision among FSWs.

Of the interviewees, 17.7 per cent preferred having sex with circumcised men because they believe the risk of HIV infection is nil. Some 20 per cent of the 60 FSWs that reported to be HIV-positive had not used a condom in their last sexual encounter before the interview. One interviewee summed up the misconception of using circumcision as a 'natural condom' this way:

"A man who is not circumcised takes long to ejaculate and at times such men want to have sex with you without a condom such that they can infect you. But a man who is circumcised can even rape you without a condom and you do not get infected."

With regard to condom use, 187 (72.5 per cent) said they used condoms with steady clients every time while 67 (26 per cent) said they used condoms occasionally.

"Meanwhile, four FSWs (1.5 per cent) said they never used condoms with their steady clients and three of these did not think that circumcised men could infect someone with HIV yet they had had STIs in the past three months," the report partly reads.

The report notes that the 60 per cent protective effect from HIV/Aids that is associated with safe male circumcision (SMC) is likely to trigger a high propensity for risky sexual behaviour and worsen the incidence of HIV.

...

MALAWI: "Voluntary" circumcision to replace force?

New Times Africa
August 25, 2014

Malawi shifting away from forced male circumcision

Forced male circumcision sparks debate in Malawi
by Moses Michael-Phiri
BLANTYRE, Malawi (AA) – It was around sunset on a chilly day in the populous Ndirande Township in Blantyre, Malawi’s commercial hub, where a group of cheering boys had gathered around a dusty pitch to watch some of their peers play football. That’s when they pounced.

Picking one of the smallest boys on the touchline, mysterious men dragged their seven-year-old victim away, undisturbed by his efforts to break loose, only leaving behind a dusty trail as they disappeared with their prey into the bush.

The boy tried to cry for help. But only a muffled sound came out of his mouth as one of the men had gagged him until they had brought him into a grass-thatched hut.

That very moment, the other boys realized that their friend had been taken for circumcision. They all took to their heels – some to alert the boy’s parents.

A traditional initiation ceremony – or “chinamwali,” also popularly known as “jando,” in which circumcision is carried out – was taking place quietly in the nearby hut.

Between May and August, local circumcision ceremonies swing into full gear in most parts of the country.

Trespassers are abducted, circumcised and ordered to pay hefty “fees” to elders, locally known as “ngaliba” (surgeons).

Local elders occasionally send boys to capture other boys suspected of not being circumcised in an effort to increase the number of initiates – and raise money.

Elders demand 7000 kwachas (about $18) in fees for the “initiation” of a seven-year-old boy.

“We tried to settle the matter amicably, but the initiation elders were not moved,” the relative of the boy told Anadolu Agency, asking not to be named.

“They demanded their fees be paid in full before they could release the boy,” he said.

“Village headman Mtambalika, the local chief of the area, paid 1000 kwachas [about $2] for the boy’s release,” added the relative.

The parents declined to talk to AA, but the relative suspected that they were in favor of the boy’s circumcision.

“It’s tradition; boys have to be circumcised, especially in the Muslim communities in this area,” he said. “No wonder the parents are quiet about it.”

-Abducted-
But one of the country’s most prominent lawyers, Zwelithini Chipembere, has decried the practice.

“Those who forced circumcision on the boy have to pay the price,” he told AA.

“This is total abuse of human rights. No one should be forced to be circumcised,” Chipembere insisted.

“This was an innocent seven-year-old boy who went out to have fun.”

He asserted that the initiation hut had been intentionally built near a school playground, where children can often be found playing.

“It is a serious matter; I am still trying to get more information from the parents and police so we can open a court case,” the lawyer said.

“All I want is to find out who abducted the boy to be circumcised,” he added.

So far, he lamented, no one had been arrested over the incident.

-Debate-
The incident has added fuel to an already raging debate across the country about circumcision ceremonies.

Initiation huts have sprung up to target schoolboys on holiday (May to August), which is a cold season in Malawi – a climate said to make circumcision less painful and make wounds heal quickly, according to a local initiation elder.

The Malawian government is already under fire for moving too slowly in providing free male circumcision services at state facilities.

Earlier this month, the government announced it would scale up a voluntary medical male circumcision (VMMC) program.

Health Ministry spokesman Henry Chimbali told AA that a massive, six-week VMMC campaign – targeting 45,000 people in six districts – had begun.

“The VMMC campaign is running in the districts of Blantyre, Lilongwe and Nkhotakota [in central Malawi] and in Zomba, Phalombe and Mulanje [in the southern region],” he explained.

Malawi launched its VMMC initiative in late 2011 as an HIV prevention strategy after being convinced by results of three random clinical trials that had shown that the service led to HIV prevention rates of 60 percent.

The campaign also aims to curb forced or unsafe male circumcisions carried out during initiation ceremonies.

The World Bank has agreed to fund the program – to the tune of some $15 million – for the next four years.

“VMMC also benefits the recipient in terms of hygiene, prevention of cervical cancer in female partners, and prevention of penile cancer,” Chimbali said, adding that over 140,000 men in the country had undergone VMMC.

Frank Chimbwandira, director of the Health Ministry’s HIV/AIDs department, said that while the government had excluded some districts in the northern region from the campaign, the project was focused on areas known for high HIV prevalence rates.

But, he insisted, people should understand that VMMC is not a 100-percent HIV/AIDS prevention measure.

“We encourage those who have undergone VMMC to still use condoms in order to stay safe from contracting HIV,” Chimbwandira told AA.
[Then what possible difference can having been circumcised make?]

VMMC facilities have been opened in primary schools in order to make the service available to the people, especially the young, he said.

The campaign has received an overwhelmingly positive response, the official asserted, with people flocking to the facilities to receive the service.

As to whether the campaign would bring an end to traditional circumcision ceremonies, Chimbwandira said: “Maybe, because it [traditional means of circumcision] is barbaric; it has to end.”

© 2014, .

KENYA: Circumcision Secretariat Closes

The Star
August 25, 2014

Kenya: Circumcision Secretariat Closes

by John Muchangi
The secretariat that coordinated all voluntary medical male circumcision in Kenya the last six years has closed.

The Male Circumcision Consortium (MCC) started in 2007 in Kenya and has been key in promoting the male cut to prevent HIV in Kenya.

It was the body that reached out to the Luo Council and of Elders and Former Prime Minister Raila Odinga to popularise male circumsion Nyanza, where it is not traditionally practised.

Voluntary medical male circumcision has reached almost 700,000 men, up from 7,000 in 2008 when it was officially adopted in Kenya, according to the Ministry of Health.

MCC was the secretariat of the national taskforce on VMMC and linked the different groups carrying out medical male circumcision in Kenya.

It was funded by Bill and Melinda Gates Foundation and was initially planned to close in 2012 but was extended by two more years.
[Rather typical of Western interventions in Africa. Come in with a hiss and a roar - "We're going to save you!" - then leave with their tails between their legs, having achieved - what?]

"MCC was instrumental in forming the Nyanza Provincial VMMC Task Force that spearheaded the rollout of VMMC from the start, when the ground was shaky, to the present when we are firmly on solid ground," said Prof Kawango Agot, director of Impact Research and Development Organisation. "I believe that without MCC, Kenya would not have led the rest of Africa in VMMC rollout."

Officials said they sought other funding sources in vain and the closure of MCC was likely to slow down the momentum in Kenya.

Male circumcision has been proven to cut the risk of men acquiring HIV by about 60 per cent and remains a key prevention strategy in Kenya.
["Proven" - based on 73 circumcised men who didn't get HIV less than two years after 5,400 men were circumcised, while 64 did. And "a key prevention strategy" when condoms are known to be much more effective.]

At least 1.5 million Kenyans are living with HIV and 58,000 die every year after reaching the Aids stage.

The consortium brought together representatives from the ministry of health, FHI 360, EngenderHealth and Nyanza Reproductive Health Society, representing the University of Illinois at Chicago.

Dr Athanasius Ochieng', who sat on MCC as the VMMC programme manager at the National AIDS and STI Control Programme (Nascop), says. "The government provides policy direction and infrastructure. However, our partners help in implementation of services, and therefore there is need to have a coordinated approach. The MCC has helped to ensure this."

The MCC has convened the task forces regularly -- monthly at first and later quarterly -- since the programme began in 2008.

Dr Elijah June Odoyo, currently the technical lead for VMMC at the US Centers for Disease Control and Prevention (CDC) in Nairobi, says that through these studies and dissemination of their results, "the MCC has cultivated a culture where evidence guides programming."
[So without the MCC there will be no evidence? And then how will they know whether male genital cutting is causing HIV to fall, to rise, or having no effect?]

MCC Senior Manager Mathews Onyango said the task force approach championed by the MCC is now considered a "best practice." He adds that "it is now being applied in scaling up interventions to address other health issues, such as prevention of mother-to-child transmission of HIV, tuberculosis and leprosy, and HIV/AIDS care and treatment."

KENYA: Another man circum-raped

Citizen News (Kenya)
August 22, 2014

Man Forcibly Circumcised In Meru

by Morgan Mueke
A man in Meru County was today, Friday forcibly circumcised after residents discovered that he had married before undergoing the cut.

The man's wife is said to have ‘let the cat out of the bag’ after a domestic quarrel.

Young men from the area frog marched him from one shop to the next fundraising for what they called ‘an expensive exercise’.

Circumcision according to Meru community is a major cultural ritual transition from a boy to a man.

They believe skipping it is like inviting ridicule and shame as a dirty man.

Residents in his village have been calling him a ‘Mwiji’, the Meru word for one who is not circumcised.

The youths said the man is ready now to be a man in the community.

Earlier story

SOUTH AFRICA: Prepex device not suspended

Mail & Guardian (South Africa)
August 21, 2014

Department refutes political link to Israeli circumcision product approval

by Mia Malan, Amy Green
An Israeli male circumcision product has not been put on hold, says the South African health department.

The health department has denied media reports in a national newspaper last week that plans to introduce the non-surgical medical male circumcision device, PrePex, to the government’s medical male circumcision programme, have been put on hold because it’s an Israeli product.

According to the department’s medical male circumcision programme manager, Dayanund Loykissoonlal, no decision has been made yet. “The minister will make his decision on the basis of our research findings, which will be concluded in February 2015. We need to make sure that whatever device we implement in the country must be safe and effective for South Africans to use. It must do what it’s supposed to do – it must be effective for HIV prevention.”

PrePex consists of an elastic band that compresses the foreskin, restricting blood supply until the foreskin dries and can be cut off after a week of the device being administered, without stitches, bleeding or anaesthetic.

Endorsed by WHO
Trade union Cosatu has called for a boycott of Israeli products and has voiced its objection to PrePex because of its Israeli origins. But Loykissoonlal says research results, and not politics, will determine the department’s decision on whether or not to introduce the device. PrePex was the first non-surgical male circumcision device to be endorsed or ‘prequalified’ by the World Health Organisation (WHO) in May 2013.

Research has shown that medical male circumcision – the removal of the entire foreskin of the penis – can [perhaps] reduce a male’s risk of contracting HIV through heterosexual sex by [up to] 60%.
South Africa first introduced medical male circumcision in 2010, and has since circumcised 1.4-million men. The government’s national strategic plan on HIV for 2012 to 2016 aims to have medically circumcised 80% of men between 15 and 49 – or 4.3-million men – by the end of the 2015/2016 financial year.

Modelling studies published in the medical journal Plos Med in 2011 showed that if South Africa reaches this target, more than 20% of new HIV infections – or one million could be averted by 2025. According to study projections, about five medical male circumcisions are needed to prevent a single case of HIV infection. [This "modelling" is all based on a total of 73 circumcised men who did not get HIV, while 64 did, out of 5,400 circumcised in three trials.]

South Africa is however not on track with reaching this target, and, is looking at ways to speed up the programme. The introduction of a non-surgical device, in addition to surgical procedures where doctors cut off the foreskin, is one such way.

PrePex is currently being tested in eight pilot sites in Gauteng, Mpumalanga and North West to test the feasibility of introducing the device as part of its medical circumcision campaign.

“We have completed the first phase of the research, in line with WHO recommendations, looking at the pilot implementation of the device. We still have the other two phases, the passive and active surveillance, left to do. Active surveillance is putting the device out there in the actual health settings and doing about 1 000. PrePex placements on clients and following them up rigorously. And passive is looking at another 9 000.”

Earlier story