Experts call for ramping up male circumcision to cut HIV infections

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Washington, August 5 : Experts at the AIDS 2008 Conference held in Mexico City on Monday called on the global health community to ramp up male circumcision to significantly reduce risk of HIV infection in Africa.

Citing new findings at the event, the experts said that a male circumcision initiative implemented by Population Services International (PSI) in Zambia suggested that cultural resistance could be overcome, and that it was possible to carry out male circumcision (MC) safely and effectively in medically unsophisticated settings, using nurses and clinical officers to do the procedures as part of a comprehensive prevention program.

Robert Bailey, an epidemiologist with the University of Illinois in Chicago, said that a recent study in Kenya showed no increased risk-taking behaviours among newly-circumcised men.

He said that compared to an uncircumcised control group, newly-circumcised men reported "increased penile sensitivity and enhanced ease of reaching orgasm," addressing fears that circumcision would reduce sexual pleasure and function.

"Based on the existing body of evidence, and our experience implementing male circumcision to strengthen our prevention efforts, we are asking the international community to help national governments and their partners to introduce male circumcision wherever HIV prevalence is greatest and circumcision rates are lowest-in the nations of eastern and southern Africa," said Dvora Joseph, Acting Director of the HIV Department at PSI, a nonprofit organization based in Washington, D.C. that addresses the health problems of low-income and vulnerable populations in more than 60 developing countries.

She said that randomised control trials conducted in Uganda, Kenya, and South Africa had shown that circumcision could reduce the transmission of HIV in heterosexual men by as much as 65 percent.

She further said that introducing it widely in sub-Saharan Africa, particularly in southern Africa where male circumcision rates were low, could prevent an estimated two million infections in the next ten years, and save as many as four million lives over the next 20 years.

"As news gets out about the efficacy of male circumcision, we need to meet that demand with quality services and a comprehensive HIV prevention approach, and scale up male circumcision as an ethical, human rights issue," said PSI's Dvora Joseph, adding that the projects in Zambia and Kenya reported a significant unmet demand for circumcision among men, leading at times to a two-month waiting list in Zambia, where 500 men have been circumcised in the last 9 months.

She highlighted the fact that many of the hardest-hit African nations are hesitating to introduce male circumcision as a prevention measure despite recommendations by WHO and UNAIDS, and that there had been little attempt to increase popular understanding of male circumcision and its impact on HIV.

"We seem to forget that we have an intervention that is 60 to 70 percent effective for preventing HIV in men, more effective than any vaccine currently under development. But the word is getting out. Just by word of mouth, the demand is so great that already men are going to unqualified practitioners and experiencing serious complications. We must scale up our response rapidly to meet the demand for safe circumcision services," said Bailey.

He said that any circumcision initiative must be integrated into existing HIV prevention programs in order to be effective.

Dr. Joseph said that PSI acknowledged that condoms and communications alone were insufficient, and that circumcision-as part of a comprehensive HIV prevention program-could have an unprecedented impact on the burden of disease.

"We were struck by this monumental research that shows circumcision having the greatest efficacy in curbing the spread of heterosexual transmission of HIV to date-greater than any vaccine in the pipeline today," she added.

Speakers at the briefing said that donors and national governments should not be overly concerned about cultural resistance to male circumcision, for cultural resistance could easily be overcome.

ANI

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