The programme to circumcise 2.1 million Malawi men has gotten off to a slow start, with only 15,000 men volunteering to go under the knife since September last year, a Ministry of Health official told The Sunday Times. The exercise is expected to run until 2016.

"The 15,000 represents just 0.7 percent of the 2.1 million (sexually active population of men) target for Malawi over a period of 5 years from 2011 to 2016. While this number shows that we are lagging behind, we expect the figure to rise significantly by end of September because demand for male circumcision has now increased," Henry Chimbali, spokesperson of the ministry of health, has said.

He said the country's HIV prevalence rate demands that Malawi circumcises approximately 2.1 million sexually active men within five years from 2011. He said, to achieve this, targets have been set for each district and experts are monitoring progress on targets.

"However, we are currently less than 1% of our target. But this has been due to some in-house keeping issues such as policy, scale up plan of the campaign, communication plan and human resources.

"We have made progress in almost all these and soon we may see a very fast pick up of the services. We also currently have so many partners coming forward to assist," he said.

Under this programme, male circumcision is the complete removal of foreskin by skilled health care workers in a health facility.

Practiced for a long time as part of Malawi's social, cultural and medical reasons, it remains one of the oldest and most common surgical procedures performed globally, said Chimbali.

One study in South Africa showed a 60 percent reduction in HIV acquisition among circumcised men aged 18-24 years. Subsequently, two other studies in Kenya and Uganda have demonstrated reduction in risk of HIV acquisition of 53 percent and 48 percent, respectively, among circumcised men.

Chimbali said, among other benefits, circumcision reduces the risk of HIV infection, saying the "foreskin is also susceptible to acquisition of HIV because it has higher density of langerhans cells which have receptors for HIV."

About 10 percent of Malawi's population is infected with HIV, the virus that causes Aids. Over 300,000 people have enrolled for free Aids drugs, from 5,000 in 2004.

Chimbali said with modern healthcare facilities, circumcision was being sought out "both as part of the traditional process and as uncircumcised men become increasingly aware of the benefits."

Currently in Malawi, the majority of circumcision taking place is in the context of religious and traditional