Circumcision weeks: making circumcision part of routine training and service delivery at district-level hospitals in South Africa

Abstract

Background: Medically safe, elective male circumcision supports traditional and cultural rites of passage by reducing the risk of adverse events and death among men undergoing initiation. It is a way of preventing penile conditions that arise from being uncircumcised. It also protects against various sexually transmitted infections, playing a particularly important role in human immunodeficiency virus (HIV) prevention, as it protects against HIV infection in men by up to 60%. It also helps reduce herpes simplex virus type 2, a key biological co-factor thought to account for some human susceptibility to HIV infection and human papillomavirus. To address these needs and to meet the World Health Organization’s call to upscale male circumcision to 80% in HIV/AIDS epidemic-gripped sub-Saharan Africa, there is a need to provide male circumcision as standard care in district health. Method: A retrospective review of three years of circumcision services, using the sleeve method, and not the high-volume, forceps-guided method, and training at a Level 1 district hospital in South Africa. Results: Two hundred and twenty-one medical circumcisions were performed, increasing significantly in each successive year. Mostly, they were carried out under local anaesthetic, and there were only four complications, all of which were successfully resolved. The average age of the patients was 20, and generally, they elected to have medical circumcision carried out for cultural reasons. Some 60 students and clinicians were trained in safe medical male circumcision. Conclusion: To meet the growing demand for male medical circumcision, especially among teenagers and young adult men at district-level hospitals, there is a need to significantly expand the surgical competency of clinicians in this field. “Circumcision weeks” are one way of routinely upscaling surgical skill levels, while simultaneously responding to increased patient demand for safe medical circumcision.

Keywords: safe male circumcision, minor surgery competency, training, district health services