Fistula, usually occurring in women due to difficult labour, is increasingly being reported in young boys circumcised within the national HIV control programme.

Last year, the US President’s Emergency Plan for Aids Relief (Pepfar), the main donor to HIV in Kenya, suspended the circumcision of boys aged under 15 due to safety concerns. This followed an investigation which found 36 boys and infants had lost their manhood in the 15 African countries implementing the project.

The highest number of circumcision-related serious injuries were in boys aged under 15 with the most recorded in Kenya and South Africa. Pepfar had, however, suggested the suspension could be lifted if project managers addressed the issue and made circumcision safer.