It’s an idea that can make a grown man cringe and cross his legs, and no one knows better than Angelo Kaggwa. But Kaggwa finally got circumcised last year and immediately reduced his risk of infection with the AIDS virus dramatically. Now, he wants everyone to know: It’s not so bad.
Kaggwa, 29, is telling anyone who will listen at the International AIDS Conference in Washington, D.C. “This conference is a really good platform to reach out,” he said in an interview.
The studies are clear: Circumcising heterosexual men reduces their infection rate by at least 60 percent and some studies show it’s by 65 percent or more.
While that’s of little help to the gay and bisexual men who are still the most at risk from the human immunodeficiency virus that causes AIDS, the United Nations calculates that if 20 million high-risk men were circumcised by 2015, 20 percent of HIV infections would be prevented over the next 10 years. That could save $16.6 billion in future medical costs.
"We want the world to know that this procedure reduces the risk of female-to-male transmission by more than 60 percent and for the rest of the man's life, so the impact can be phenomenal,” U.S. Secretary of State Hillary Clinton told the conference on Monday.
Wives and partners of these men are protected by extension if the men have sex with someone else. Clinton praised a group of at least a dozen Zimbabwean legislators who got themselves circumcised last week.
"That's the kind of leadership we welcome,” she said. “On male circumcision, we've supported more than 400,000 procedures since last December alone. And I'm pleased to announce that PEPFAR (the President’s Emergency Fund for AIDS Relief) will provide an additional $40 million to support South Africa's plans to provide voluntary medical circumcisions for almost half a million boys and men in the coming year .”
But, according to the advocacy group AVAC (formerly the AIDS Vaccine Advocacy Coalition) only 8 percent of the 20 million targeted men actually have had the procedure.
Kaggwa’s experience demonstrates that it may take more than statistics and speeches to persuade men. Word of mouth may be one of the most effective tools.
“I think people get a real visceral reaction,” AVAC’s Mitchell Warren told NBC News in an interview. “Someone once described it as minor surgery on a major organ.”
The procedure is usually done soon after birth in many societies, but it's being advocated for adults as a tool to help control the spread of HIV.
Kaggwa, originally from Kampala, Uganda, said he thought about circumcision for years but was put off by the fear of pain, the expense and the time it would take. He finally took the plunge at a PEPFAR-funded free clinic in Kisumu, Kenya. It wasn’t nearly as bad as he had feared, he said.
“The issue of pain kept coming up. I found out it was only in my head,” Kaggwa said. “It’s almost painless. It’s amazing. I was on a work trip, and as soon as the circumcision was done I was back to work … I just walked out of the theater and went back to my duties.”
Kaggwa, who lives in New York now and works for AVAC, said men will come up with any excuse not to be circumcised: they are busy, it will take too much time, it will hurt.
These are just lame excuses, he said. A one-on-one conversation can change minds, he said. “I personally know nine people who have been circumcised because of my story. I made a personal pledge to tell anyone who cares to listen.”
Circumcision protects men for a number of reasons. The foreskin is full of the immune system cells that are the most vulnerable to the virus. The tender tissue can also get tiny tears and scratches during sex that give the virus an easier entry point. And men with foreskins are far more likely to get other sexually transmitted diseases such as gonorrhea and syphilis, which, in turn, raise the likelihood of HIV infection.
“I definitely feel safer. I feel cleaner, too. I love the fact that I have protection by up to 60 percent," Kaggwa said.
Also, women may prefer circumcised partners, according to a new survey presented at the conference.
Timothy Okeyo and colleagues at the Nyanza Reproductive Health Society in Kenya interviewed 101 women whose partners had been circumcised.
“All female participants reported being satisfied with their partner's decision to become circumcised and his sexual performance after circumcision. Ninety-six percent were satisfied with the appearance of partner's penis and 91 percent reported enjoying sex more after circumcision,” Okeyo told the conference.
Three-quarters of the women said improved hygiene was a reason to get circumcised and 90 percent knew that a man was more likely to get HIV if he was not circumcised. Only 18 percent of the women and 6 percent of the men said they would be more likely to skip the condom when having sex. Researchers had feared that circumcision programs would increase risky sexual behavior, but Okeyo said the survey findings were reassuring.
As for one of the biggest questions surrounding adult circumcision, Kaggwa, who is single but has a steady girlfriend, is also reassuring.
“It hasn’t affected my sex life,” he says shyly.
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