This week, I thought I could revisit the topic on circumcision. I had written about this issue a few years ago and below was a contribution from a colleague, Samuel Kumar of Kitwe who is an HIV/AIDS activist.
I have in recent weeks received calls from some of the readers of this column to do something on voluntary male medical circumcision.
Science behind circumcision:
Skin has two main layers, Epidermis and Dermis. Epidermis is the first layer under the keratinized outer layer and then followed by the dermis. Keratinized layer is composed of dead cells and impermeable to any pathogen unless there are cuts.
Outer foreskin is keratinized (dead cells) but internal (when the foreskin is flipped over) mucosal surface of the foreskin is thinly keratinized and rich in cells called Langerhans cells that are targeted by HIV.
Under the flipped over foreskin there are epithelial cells that has a specialised type of cells called Langerhans cells that has a high affinity to HIV, Langerhans cells bind to HIV and  then HIV is transported to lymph nodes where there are CD4 positive T cells for further infection. CD4 cells are like the generals of our immune system (sometimes improperly referred to as soldiers), they are responsible for giving signals / instructions to other cells called B cells (cells that make antibodies) and CD8 cells (cells that destroy other infected cells) to make an immune response and destroy the pathogen, unfortunately the very CD4 cell also called T cells, that evokes an immune response becomes a target for HIV. The CD4  cells becomes a  virus factory, since HIV injects its genetic material called RNA into the CD4 cell , and the CD4 cell becomes infected making more copies of HIV . Hence the very purpose of CD4 is lost and it is made to make viruses.
When the foreskin is removed there is very less mucosal area and hence less targets for HIV, Also the head of the penis called the glans, gets keratinized and becomes impermeable to HIV, however HIV can still enter through the Urethra (urinating hole) and there could also be other ruptures in the head of the penis or genital infections that makes it easy for HIV to bind to target cells, hence circumcision is only 60 percent effective.
Benefits of circumcision:
Intact foreskin is associated with infections -Genital ulcer disease
Urinary tract infections in infants – 12 fold increased risk in uncircumcised boys
Syphilis – 1.5-3.0 fold increased risk in uncircumcised men
Cancroid – 2.5 fold increased risk in uncircumcised men
Human Papilloma Virus (HPV) – 63 per cent reduction in circumcised men
Invasive penile cancer in men -22 times more frequent in uncircumcised men
Cervical cancer in female partners – 2.0 – 5.8 times more frequent in women with uncircumcised partners
If you are circumcised you are still at a 40 per cent chance of contracting HIV  from a HIV positive female partnerThe virus can still permeate through the urinary hole (urethra) that has mucosal membrane.
The virus can still permeate through ruptures in the Glans (head of the penis)
If there are STD’s in the female partner then the viral load spikes and the male partner becomes more vulnerable, and also the mucosal barrier is thin, this can easily permeate HIV as well.
If you are circumcised you will still need to practice safe sex.
Also if the male has genital ulcers, then his chances of contracting HIV becomes greater.
And for the benefit of those who are still calling, texting and emailing asking for contact numbers for Dr Sondashi, the number is 0968555730 and for Mr Maila who makes the herbal mailacin is 0966848453.
I have stated in most of my articles on herbal medicines that these are not a cure for HIV though there are some people who after taking these drugs have started testing negative for HIV. It is also important to note that the owners of the herbal medicines that I have written about in this column, encourage their patients to continue taking ARVs so that their medication is taken side by side with the conventional medication. Even I as a journalist, I have never advocated for people to stop taking ARVs when they start taking herbal medicines. I thought I should mention this because I have received a number of queries on whether I also agree that people who want to start taking herbal medicines should first stop taking ARVs if they are already on ART.
Until next week, I pen off for now but you can contact me for anything you may wish to share or to find out on HIV/IDS by writing to me on knoxngoma@gmail.com call/text +260955883143