Soka Uncobe

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Logo for the Soka Uncobe mass circumcision campaign.

"Soka Uncobe" is a phrase which means "circumcise and conquer" in siSwati, [1] and it is a campaign to implement the "Accelerated Saturation Drive," which is the Swazi government's plan to circumcise 80% of the Swazi male population aged 18-49, [2] with HIV prevention as the pretext. [3]

Rationale

Swaziland is a country where the practice of having multiple concurrent sexual partners is prevalent,[4] and the country with the highest HIV prevalence in the world. Swaziland has a very low prevalence of male circumcision,[5] and this is has been indicated as one of the "driving factors" behind the high prevalence of HIV,[6] although other studies have shown that HIV transmission was more prevalent in the circumcised population than it was in the intact population.[7]

Purpose

The goal of Soka Uncobe is to "saturate the male population with circumcision."[8] The campaign seeks to make its people view male circumcision as one of several critical HIV prevention choices that men and their partners can make to live healthier lives and save their country.[9] The Swaziland Soka Uncobe campaign focuses on encouraging women to encourage their partners to get circumcised, and to support them through their 6-week abstinence period after the procedure.[10] It also engages companies to encourage and support their male employees to get circumcised.[11]

Aid from the United States

Soka Uncobe is acting under scientific models developed by the U.S. government, which predict that a scale up of circumcision in Swaziland "will prevent approximately 45 percent of new infections between now and 2025." According to the models, By 2025, the number of new infections each year is projected to be "reduced by more than 80 percent compared with what would have happened had no intervention occurred.[12]

The plan to circumcise 80% of Swaziland's male population was approved in March or April of 2010 with the support of the US Government.[13] Since then, U.S. government personnel have worked to align PEPFAR resources in support of the national plan. The Government of Swaziland asked PEPFAR to support the national male circumcision plan as one of the "five pillars" of the Swaziland -— United States PEPFAR Partnership Framework on HIV/AIDS.[14]

In March 22, 2011, the U.S. government officially handed over a wide range of materials in support of the USDF’s efforts to combat HIV/AIDS, which included 7 prefabricated medical facilities supporting the Soka Uncobe male circumcision campaign. In all, the materials handed over at the ceremony and those that will be arriving in the future are valued at over E 12.5 million. Representing the United States Government were Charge d’Affaires Craig Cloud, joined by Dr. Anne Thomas of the U.S. Department of Defense, and in a speech given by Cloud, it was noted that "if the Soka Uncobe campaign is successful in circumcising 152,000 men during 2011, it could prevent 88,000 people from getting infected with HIV and save the government and the people of Swaziland E 4.5 billion in medical treatment costs."[15]

Mixed Message, Plan Backfiring

Soka Uncobe has already caused concern, as the message and imagery being used to promote it is sending the wrong message.[16] Advertisements promoting the campaign display four women, sending confusing messages, one being that once one was circumcised, they would be able to "conquer" more women. Regarding the logo and the slogan "Soka Uncobe" itself, some have gotten the message that “one has conquered” and would not get HIV and AIDS. The greatest concern is that the message is promoting multiple concurrent partnerships.[17]

Solomon Mndzebele, a caregiver under Red Cross, made a personal plea to the Ministry of Health to remove the advertisements because they were making making his job to promote condom use difficult.[18] According to Mndzebele, "When you tell people about condoms they would just tell you that they would circumcise and by then they would have conquered HIV AIDS."

Circumcision does not prevent HIV infection

Population-based studies

September 2021 saw the publication of two huge population studies on the relationship of circumcision and HIV infection:

  1. Mayan et al. (2021) carried out a massive empirical study of the male population of the province of Ontario, Canada (569,950 males), of whom 203,588 (35.7%) were circumcised between 1991 and 2017. The study concluded that circumcision status is not related to risk of HIV infection.[19]
  2. Morten Frisch & Jacob Simonsen (2021) carried out a large scale empirical population study in Denmark of 855,654 males regarding the alleged value of male circumcision in preventing HIV and other sexually transmitted infections in men. They found that circumcised men have a higher rate of STI and HIV infection overall than intact men.[20]

No association between lack of circumcision and risk of HIV infection was found by either study. There now is credible evidence that the massive, expensive African circumcision programs have not been effective in preventing HIV infection.

Two African surveys

The previously reported studies were from developed Western nations. Now we have information from Sub_Saharan Africa.

French scientist Michel Garenne, Ph.D. has published two reports in 2022 comparing the incidence of HIV infection in circumcised and intact men.

In his first report, Garenne presented the findings from a study in Lesotho, the enclave in South Africa. He reported:

In couple studies, the effect of circumcision and VMMC on HIV was not significant, with similar transmission from female to male and male to female. The study questions the amount of effort and money spent on VMMC in Lesotho.[21]

In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe). He reported:

"Results matched earlier observations made in South Africa that circumcised and intact men had similar levels of HIV infection."[22]

References

  1. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: The plan is being launched as “Soka Uncobe” (“Circumcise and Conquer” in siSwati).
  2. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: The emphasis is on reaching 80 percent coverage with the Soka Uncobe campaign...
  3. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: But the biggest motivator for male circumcision services is the protection from HIV that circumcision affords.
  4. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: In a country with the practice of having multiple concurrent sexual partners and the highest HIV prevalence in the world...
  5. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: Since Swaziland is a very small country with a very high prevalence of HIV and a very low prevalence of MC, it provides a very good case study on the relationship between MC and HIV infections prevented.
  6. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: Various studies have identified main drivers of the epidemic: multiple concurrent sexual partners, low levels of male circumcision, inconsistent use of condoms and long periods of premarital sexual activity.
  7. ↑ REFnews (2008)."Swaziland Demographic and Health Survey 2006-07", Mbabane, Swaziland: Central Statistical Office and Macro International Inc.. Retrieved 6 May 2011.
    Quote: As Table 14.10 shows, the relationship between HIV prevalence and circumcision status is not in the expected direction. Circumcised men have a slightly higher HIV infection rate than men who are not circumcised (22 percent compared with 20 percent).
  8. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: This is different because it’s a population-level activity meant to saturate the male population.
  9. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: ...the goal... is to have people view male circumcision as one of several critical HIV prevention choices that men and their partners can make to live healthier lives and save their country.
  10. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: ...women will play an active and important role in supporting their partners to get circumcised, especially in terms of observing the six-week abstinence period following the procedure.
  11. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: In late March, sugar cane companies will give their employees a few days of leave to get circumcised and have some recovery time before beginning the annual harvest.
  12. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: Scientific models developed by the U.S. government predict that this scale up in Swaziland will prevent approximately 45 percent of new infections between now and 2025.
  13. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: In March or April of 2010, the Swazi Cabinet approved the current plan, which the U.S. government agreed to support.
  14. ↑ REFnews Mazzotta, Meredith (4 March 2011)."Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year", Science Speaks: HIV & TB News. Retrieved 6 May 2011.
    Quote: The Government of Swaziland asked PEPFAR to support the national MC plan as one of the five ‘pillars’ of our “Swaziland – United States PEPFAR Partnership Framework on HIV/AIDS.”
  15. ↑ REFnews Press Release. "U.S. Government Hands Over E 12.5 Million in Materials and Equipment to USDF to Fight HIV/AIDS", Embassy of the United States, Mbabane, Swaziland. Retrieved 13 May 2011.
    Quote: 2011-03-22
  16. ↑ REFnews Ndlangamandla, Nelsiwe (4 May 2011)."'Soka uncobe' campaign questioned", The Swazi Observer. Retrieved 13 May 2011.
    Quote: THE public has received the Male Circumcision campaign "Soka Uncobe" with mixed feelings as some people have come out to say the message was not clear.
  17. ↑ REFnews Ndlangamandla, Nelsiwe (4 May 2011)."'Soka uncobe' campaign questioned", The Swazi Observer. Retrieved 13 May 2011.
    Quote: »If it had been the picture of a family including the wife supporting her man, who goes to circumcise then that would be better, but in this case you see four beautiful women and it says they are going to support you, it is really confusing. Are they now promoting multiple partners?« said one of the people who raised a concern.
  18. ↑ REFnews Ndlangamandla, Nelsiwe (4 May 2011)."'Soka uncobe' campaign questioned", The Swazi Observer. Retrieved 13 May 2011.
    Quote: Solomon Mndzebele, who is a caregiver under Red Cross, made a personal plea to the ministry of health to remove the message from the kombis stating that it was making his work difficult.
  19. ↑ REFjournal Mayan M, Hamilton RJ, Juurlink DN, Austin PC, Jarvi KA. Circumcision and Risk of HIV Among Males From Ontario, Canada. J Urol. 23 September 2021; PMID. DOI. Retrieved 21 August 2022.
    Quote: We found that circumcision was not independently associated with the risk of acquiring HIV among men from Ontario, Canada.
  20. ↑ REFjournal Frisch M, Simonsen J. Non-therapeutic male circumcision in infancy or childhood and risk of human immunodeficiency virus and other sexually transmitted infections: national cohort study in Denmark. Eur J Epidemiol. 26 September 2021; 37: 251–9. PMID. DOI. Retrieved 16 January 2022.
  21. ↑ REFjournal Garenne M. Changing relationships between HIV prevalence and circumcision in Lesotho. J Biosoc Sci. 4 April 2022; online ahead of print: 1-16. PMID. DOI. Retrieved 7 November 2022.
  22. ↑ REFjournal Garenne M. Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa. J Biosoc Sci. 26 October 2022; : 1-13. PMID. DOI. Retrieved 7 November 2022.
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