AIDS-hit countries urged to increase male circumcision

Aug 5, 2008, 22:42 GMT

Washington/Mexico City - Male circumcision can prevent 65 per cent of new HIV infections in adult heterosexual men, but AIDS- hit countries are lagging in their efforts to promote it, researchers said Tuesday.

With no vaccine or cure for AIDS, many health experts believe male circumcision could drive the epidemic into a declining state toward extinction. They urged countries with high rates of HIV infections being transmitted predominantly through heterosexual contact to include circumcision in a comprehensive HIV prevention strategy.

Unlike other prevention methods, circumcision is unique, because it is a 'one-time treatment.'

Current HIV prevention tools - abstinence, using condoms, early diagnosis and treatment of sexually transmitted infections, and HIV testing - all have their limitations.

Antiretroviral treatment isn't available to millions of HIV- infected people who need it, and a vaccine is still decades away.

Circumcision protects men who have undergone the surgery, but there is no evidence that the lack of a foreskin in men carrying HIV reduces transmission of the virus to their sexual partners.

Some countries and donors are reluctant to ramp up male circumcision efforts over concerns of lack of hygenic and safe settings to perform the procedure, or fears that circumcision would lead to high-risk behaviours as men might feel they have a 'natural condom.'

A recently published study in Kenya reported no increased risk- taking behaviours among newly circumcised men, said co-author Robert Bailey, an epidemiologist at the University of Illinois at Chicago.

Bailey was one of the first to discover that, for a number of reasons, circumcision protects against HIV infection in men who are circumcised. Specific cells in the foreskin are favoured targets for HIV, and the inside of the foreskin lacks the tough layer that protects most skin from infection.

Many men fear that circumcision would reduce sexual pleasure. But Bailey presented a new study at the XVII International AIDS Conference in Mexico City, concluding that compared to an uncircumcised control group, newly circumcised men reported 'increased penile sensitivity and enhanced ease of reaching orgasm.'

Dvora Joseph of Washington-based non-profit Population Services International (PSI), said: '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.'

PSI projects in Zambia and Kenya reported an unmet demand for circumcision among men, leading to a two-month waiting list in Zambia, where 500 men have been circumcised in the last nine months.

Introducing circumcision widely in sub-Saharan Africa, particularly in southern Africa where male circumcision rates are low, could prevent an estimated 2 million infections in the next 10 years and save as many as 4 million lives over the next 20 years, PSI said.

The strongest evidence of the benefits of male circumcision came in 2007 from three trials - in Kisumu in Kenya, Rakai district in Uganda and Orange Farm in South Africa - which revealed male circumcision reduced the risk of heterosexually acquired HIV infection in men by 60 per cent.

In fact, all three trials were stopped before completion because of the overwhelming evidence of the protective effect of circumcision.

At least 25 per cent of men worldwide are circumcised. In Africa, about 68 per cent of men are circumcised, a practice observed more for cultural and religious than health reasons.

Male circumcision is probably the oldest and most common surgery performed in human beings, first used by the Egyptians more than 4,300 years ago.

Despite the evidence, many of the hardest-hit African nations are hesitating to promote safe, accessible circumcision services to male citizens, and there has been little attempt to disseminate information about circumcision and its impact on HIV.

'We seem to forget that we have an intervention that is 60 to 70 per cent effective for preventing HIV in men, more effective than any vaccine currently under development,' epidemiologist Bailey said.