Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia Version 2.5C (Jan08)
Chapter 2
Linking male circumcision to other male sexual and reproductive
health services
Summary
• Men have different sexual and reproductive health needs at
different ages.
• Male circumcision reduces the risk of acquiring HIV infection by
50–60%, but does not guarantee complete protection. In addition,
it may provide some protection against other sexually transmitted
infections, such as syphilis and herpes, but offers little or no
protection against gonorrhoea and chlamydia.
• Male circumcision does not prevent unwanted pregnancy.
Comprehensive education and information programmes, and the
provision of services for contraception and STI prevention and
management, are needed to address male sexual and
reproductive health needs.
• WHO and UNAIDS recommend HIV testing and counselling for all
patients who have signs and symptoms of HIV infection. In certain
epidemic situations, they recommend routinely offering an HIV test
at every contact with health services.
• WHO and UNAIDS recommend that all men who request
circumcision to reduce their risk of HIV infection should be offered
an HIV test.
• The core goals for male sexual and reproductive health services
include promoting responsible male sexual behaviour and
encouraging men to support their female partners and children in
meeting their sexual and reproductive health needs.
• Sexual and reproductive health education and services are
important for men and adolescents, as well as for women. A wide
range of people and organizations can provide information and
services, including parents, teachers, nongovernmental
organizations, churches and youth groups, as well as health care
providers in outpatient, family planning, STI, and HIV clinics. Every
opportunity to provide education and services should be taken.
• Male circumcision services for older boys and young men offer an
opportunity to provide sexual and reproductive health education
and counselling to these key groups.
Linking male circumcision and other male SRH services Chapter 2-1
Male circumcision under local anaesthesia Version 2.5C (Jan08)
MEN'S SEXUAL AND REPRODUCTIVE HEALTH NEEDS AND SERVICES
For many men, accessing circumcision services may be their first contact
with health services. This contact offers an opportunity to address other
aspects of men’s sexual and reproductive health.
As noted in Chapter 1, male circumcision does not provide full protection
against HIV, but appears to reduce the risk of infection by 50–60%. It
gives little or no protection against STIs that affect the urethra, such as
gonorrhoea and chlamydia. It provides no protection against acquisition of
HIV infection from unsafe injections, from infected blood products, or
through receptive anal intercourse. It also does not prevent pregnancy.
To reduce the risk of STIs, including HIV, and unwanted pregnancy,
comprehensive education and information programmes are needed, as
well as services for contraception and STI prevention and management. A
possible consequence of promoting male circumcision for HIV prevention
is that circumcised men may perceive themselves as immune, and
subsequently increase their exposure to HIV, ignoring other important
strategies to reduce risk. These strategies include delaying the onset of
sexual activity, reducing the number of sexual partners, and using
condoms correctly and consistently every time they have sex.
In many societies where male circumcision is performed at the beginning
of adolescence, as a rite of passage to adulthood, the circumcision
festival period is used also to educate young men about various health
and social issues. These cultural traditions can be harmonized with
modern clinical practice, to ensure the safety of circumcision, and to use
the opportunity to educate the young men about a number of sexual and
reproductive health issues.
Male circumcision should therefore be regarded as an entry point for
sexual, reproductive and other health services for men (Fig. 2.1),
including:
• sexual and reproductive health education and counselling;
• screening and treatment for sexually transmitted infections;
• counselling and testing for HIV (with referral for care and support
for those testing positive);
• family planning education, counselling and services, including
provision of condoms and vasectomy;
• evaluation and treatment for infertility;
• counselling on gender issues, including promotion of respect for
women’s and girls' sexual and reproductive health needs and
rights and the importance of preventing gender-based violence;
• education about cancers of the male reproductive organs (testes,
penis and prostate);
• counselling for alcohol dependence and other substance abuse,
which are associated with a number of health risks.
Linking male circumcision and other male SRH services Chapter 2-2