Health facilities in Nyanza Province in western Kenya are struggling to meet the demand for medical male circumcisions since politicians threw their weight behind efforts to promote the procedure as a way of reducing HIV infections.

The campaign initially faced opposition by community elders of the ethnic Luo community that makes up the bulk of the province's inhabitants and does not traditionally practice circumcision. But local leaders, swayed by calls from Kenya's Prime Minister, Raila Odinga, and research demonstrating the HIV prevention benefits of being circumcised, have since said they would set an example by undergoing the procedure themselves.

"I think it is a good thing that people are now seeing the benefits that will come along with male circumcision. After all, this has nothing to do with culture because it is a medical procedure," said Oburu Odinga, a local legislator who is among those who have volunteered to be circumcised. "The day I go for it, I will let all know that I have done it."

The sudden increase in demand for medical male circumcision in the province has forced health officials to rapidly roll out a programme to train health workers in the procedure.

"We have so far trained over 100 trainers of trainees, who will in turn train health workers," said Wycliffe Omondi, a clinical instructor at the Nyanza Reproductive Health Society, part of a joint project by UNIM - the Universities of Nairobi in Kenya, Illinois in the US, and Manitoba in Canada - in Kisumu, provincial capital of Nyanza.

Trainers receive two weeks of training; health workers - clinical officers, nurses, counsellors and infection prevention assistants - receive five days, which includes counselling and the detection of dangerous conditions that might arise during surgery, such as excessive bleeding.

"Research assistants are also trained to follow up on clients after circumcision to monitor the healing process," Omondi told IRIN/PlusNews.

Fred Oduor, another instructor with the UNIM project, noted that "We will not turn away those seeking circumcision services even though they are already infected [with HIV]," he said. "The only difference is that they will be required to come along with their partners. This also applies to those with sexually transmitted infections."

Awareness campaigns have also been launched to address the misconception that male circumcision provides complete protection against HIV infection, and to encourage married men to attend counselling sessions with their spouses before the procedure.
"We insist on spousal involvement for married men because that is very critical in the success of the whole process," said Omondi. "This is important for the man because the wife needs to understand that there is post-circumcision abstinence."

One issue that may lessen the success of the circumcision drive is the perception among wives that their husbands intend to be unfaithful. "The moment I mentioned to her that I wanted to be circumcised, she went mad at me and insisted that I have been unfaithful to her all along," Erick Otieno*, 35, told IRIN/PlusNews.

"You know it is difficult to convince her that you want to reduce your chances of contracting HIV without making her feel cheated on. I think it is important to create awareness among women that seeking male circumcision is not a sign of infidelity."

Irene Aluoch*, 28, said her husband was not circumcised but she would support him if he wanted it. "I know it is a difficult thing to think that your husband might be going for circumcision because he sleeps with other women, but you would rather be safe than to regret," she said. "Maybe he wants to do it just for reasons that are purely hygiene related."

The provincial AIDS coordinator, Dr Charles Okal, said such matters should be properly dealt with during counselling before surgery. "Issues of infidelity amongmarried couples are very serious and the concerns being raised by women about them cannot be wished away. We are working very closely with the providers to try to pacify such feelings in a genuine way," he said.

"If you talk about circumcising large numbers of people, but in the process have equally large numbers of broken marriages, then there is no success to write home about."

*Not their real names

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