Men's Health in Africa. Part 1: Reproductive urogenital diseases and human immunodeficiency virus infection
While acknowledging that the concept of 'men's health' is not clearly defined, and that the geographic designation 'Africa' involves immense demographic heterogeneity, the aim of this paper is to present a review of reproductive and urogenital aspects of men's health, including the effect of sexually transmitted infections in Africa. Infertility is particularly distressing in African societies, and is usually attributed to the woman, although male-factor infertility is increasingly being recognized. Polygamy is still relatively common in some countries as a male strategy to extend reproductive ability. Men's knowledge of, and attitudes to, family planning in some parts of Africa is still poor. The prevalence, etiology and treatment of erectile dysfunction in Africa is similar to that in other countries, but traditional (herbal) remedies are also widely used. Hereditary hemoglobinopathy is relatively common in West Africa, and priapism occurs in approximately one third of men with sickle cell disease. Parasitic infestations such as schistosomiasis and filariasis are still common in tropical Africa, and are a cause of significant male urogenital morbidity and even mortality. Sexually transmitted infections are relatively common in many African countries, and are a prominent cause of infertility, urethral stricture disease and Fournier's gangrene. In many sub-Saharan countries the average life expectancy of the population has decreased considerably due to the epidemic of human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). Ritual circumcision is a cause of morbidity and even mortality in some areas. Recently, randomized, controlled clinical trials conducted in three African countries have provided evidence that the risk of acquiring HIV infection is approximately halved by adult male circumcision. Overall, there is a clear need for health education and increased attention to the reproductive health concerns of males. Sustained efforts to improve the general level of education and to increase child survival are key factors in addressing male reproductive health issues. Moreover, proper management of age-related conditions in both males and females could have an impact on societies in Africa like nowhere else in the world, because the surviving elderly population will be the ones taking care of the HIV/AIDS orphans. © 2008 WPMH GmbH.