Kenya misses male circumcision target, putting HIV, STI prevention goals at risk
Nurses carry out voluntary medical male circumcision procedure on a boy.
What you need to know:
- The country aimed to perform 97,220 male circumcisions in the year under review, but only 65,550 were completed, resulting in a shortfall of 31,670.
Kenya missed its male circumcision target for the year ending June 2024 by more than 31,000 procedures, jeopardising its strategic goals of reducing new HIV infections, sexually transmitted infections (STIs) and viral hepatitis cases, according to a recent audit.
Auditor General Nancy Gathungu reported that the country aimed to perform 97,220 male circumcisions in the year under review, but only 65,550 were completed, resulting in a shortfall of 31,670.
Several factors may have contributed to the failure to meet the circumcision target, including funding constraints that limited the availability of medical equipment, trained staff and outreach programmes.
In addition, the demand for circumcision services may have outstripped the number of trained health workers.
At the same time, some communities continue to resist circumcision due to long-held cultural or religious beliefs, which can affect service uptake.
The lingering effects of the Covid-19 pandemic have also disrupted health systems, delaying elective procedures such as circumcision. Further, lack of awareness and community engagement may have contributed to lower participation rates.
"The project planned to perform 97,220 medical male circumcisions. However, only 65,550 were performed, resulting in an unmet target of 31,670, or 33 percent,” said Ms Gathungu.
This shortfall raises serious concerns about the effectiveness of Kenya's Voluntary Medical Male Circumcision (VMMC) programme, a key public health initiative aimed at reducing infection rates and improving long-term health outcomes.
Research by the World Health Organization and the Joint United Nations Programme on HIV/AIDS shows that male circumcision can reduce the risk of heterosexual transmission of HIV by about 60 per cent.
It also reduces the likelihood of contracting other sexually transmitted diseases such as syphilis, human papillomavirus and genital herpes. It also improves hygiene and reduces the risk of penile and cervical cancer in female partners.
Kenya has implemented the VMMC programme as part of a broader national HIV prevention strategy, particularly in regions with high infection rates. However, failure to meet circumcision targets could hamper national efforts to control new infections and achieve long-term disease reduction targets.
New HIV infections
The National Syndemic Diseases Control Council reported 22,154 new HIV infections in 2023, including 5,122 cases among men.
"These figures are a stark reminder that we cannot afford to slow down our prevention efforts," the council said, adding: "Voluntary medical male circumcision is one of our most effective tools, and missing the target means we are leaving many at risk of infection."
Sexually transmitted infections (STIs) remain a significant public health concern, with health facilities in Kenya expected to treat at least 309,419 cases in 2023, including chlamydia, gonorrhoea and HPV.
"We are seeing an increasing number of young people presenting with STIs," said Mr James Mworia, a Nairobi-based doctor.
"Education and prevention strategies need to be strengthened to address this growing burden."
Viral hepatitis, particularly hepatitis B virus (HBV), also poses a significant health challenge. A systematic review estimated the overall prevalence of HBV infection in Kenya at 7.8 per cent.
Unfortunately, many people are unaware that they have hepatitis B because it can be asymptomatic for years. Experts recommend strengthening routine screening, vaccination and treatment programmes to tackle this silent epidemic.
Experts note that to close the gap and meet future targets, the Ministry of Health, donor agencies and community leaders need to implement targeted interventions.
"We need to move beyond traditional hospital-based circumcision services," said a Ministry of Health official.
"Mobile circumcision clinics, greater involvement of community health workers, and increased funding will be critical to achieving our goals in the coming years."
lowoko@ke.nationmedia.com
