US entity raises age for boys cut as it slashes HIV funding

An HIV elimination project funded by the US in Kenya that supports male circumcision as a way of ending HIV and Aids will now be paying for the circumcision of boys over 15 years only.

The US President’s Emergency Plan for Aids Relief (Pepfar), the funding entity, said it is unsafe to circumcise boys below that age. 

The new changes come even as US HIV and Aids funding to Kenya declined for the second year running from Sh54.7 billion ($505 million) in 2018 to Sh40.6 billion ($375 million) in 2019 and Sh35 billion ($324 million) in 2020.

The Kenya County Plan (COP20), a strategy plan published by Pepfar in July, said Kenya’s high target achievement in the voluntary male circumcision project was largely aided by the inclusion of underage boys.

The organisation also opined that  conventional surgical circumcision for this group is associated with a higher risk of glans injuries and urethral fistula.

“Conventional surgical circumcision of boys aged 10 to 14 years will stop but may be considered later if the newly-introduced strategies for eliminating current safety concerns are fully in place,” Pepfar said.

Information published last year by the Kenya Medical Research Institute and US researchers showed that some non-governmental bodies have been recruiting underage boys for circumcision by bribing them in order to meet high targets and secure funding.

The information also showed more than 36 boys and infants have lost their manhood in the 15 African countries implementing the project with the highest casualties being in Kenya and South Africa.

Most of the injuries were due to use of inappropriate forceps that have been banned since 2014. The forceps are known to be quicker than recommended alternatives, which means more cuts and hence more funding.

“These boys have suffered injuries that may cause permanent disfigurement, functional impairment, and lifelong psychological impact,” said a report by the Ministry of Health and several US State agencies.

Consequently, previous circumcision targets set by Pepfar, as a condition to access funding, have also being revised downwards from 200,000 in 2019 to 54,844 in 2020.

Handover plans

In the COP20, covering up to September 2021, Pepfar said it will also be handing over up to 70 per cent of its HIV and Aids support to the Kenyan government. It has proposed that such support be included under the under-performing Universal Health Coverage.

Justifying the reduced funding and handover plans, the US said it is because the HIV and Aids threat has largely been brought under control. However, a look inside the new strategy suggests Pepfar may be running away from what it has found to be a corrupt operational environment.

A major concern, Pepfar said, is the rampant corruption and fraud both within and outside the public sector.

“Poor internal control is widespread in Kenya and the hundreds of millions of US taxpayer funds made available by USAid represent a ripe target for those who would seek to enrich themselves at the expense of Kenyans needing treatment and prevention services,” Pepfar said

The organisation regrets that it has to waste extra funds, time and personnel in supervisory activities against fraud. But already, some 20 local civil societies have, under the US lobby group Health Gap, objected to the proposed 2020 funding cuts by Pepfar.

Plan opposed

Funding cuts made last year, the groups said, have had a major negative impact on the quality of HIV and Aids service delivery and that more reductions could be disastrous.

“COP20 must reverse funding cuts and increase funding by $60 million (Sh6.5 billion) to the overall programme to ensure the maintenance of current successes and to improve the quality of service delivery,” said the civil society groups.

They are especially concerned over funding to key populations – groups including gays, homosexuals, transgender, male and female prostitutes, drug injectors and adolescent girls. In response, Pepfar, in the new plan, puts special emphasis on reaching key populations especially homosexuals. COP20 targets to reach 80,064 men who have sex with men with care and empowerment in 24 counties.

During the period, the project also targets to put 267,044 adolescent girls, 23,632 female sex workers, 5,279 HIV and Aids discordant couples and 311 transgender persons on the daily HIV and Aids prevention pill.