Health

Circumcision Cardinal Tool in Aids Fight

29 June 2008
By Doreen Nawa

PREVENTION measures in the fight against HIV/AIDS are repeatedly being criticised for having a limited impact on the predominantly heterosexual disease found in Africa.

As opposed to propagating the campaigns on condom use, HIV testing and treatment of sexually transmitted infections (STIs), most researchers have in the recent past been citing male circumcision as offering higher chances of protection, especially in cases of unprotected sex.

Although male circumcision and reduction of multiple sexual partnerships are currently getting less attention and resources, researchers say they are two interventions that could have a greater impact on minimising the further spread of the HIV.

Scientists say circumcision reduces men’s chances of contracting HIV by up to 60 per cent, which is regarded as a major breakthrough in the fight against AIDS. Now, the question is how to put that fact to work to combat AIDS across Africa.

The findings were first announced in December 2006, when initial results from two major trials in Kenya and Uganda - showed promising links between male circumcision and HIV transmission. However, those trials were deemed so definitive that the tests were halted early.

For instance in Zambia, HIV prevalence rate is lower in North-Western Province were male circumcision is being practiced than in other provinces countrywide.

Society for Family Health (SFH) executive director, Harrison Richard says the way the disease was evolving in Zambia was worrying.

Speaking at a Press briefing recently, Mr Richard said WHO recommendations should be taken seriously if Zambia was to experience a remarkable drop in the HIV prevalence rate.

He said major public health initiatives like male circumcision should not be ignored if Zambia was to make a difference in HIV prevention.

SFH medical expert, Dr Manasseh Phiri said North-Western Province in Zambia has the lowest HIV prevalence rate of about 6.5 per cent and the rate has been attributed to circumcision which is practiced in that area.

Dr Phiri said there was strong evidence from time immemorial from African countries in the north where circumcision is practiced that their HIV prevalence rates were lower than in other countries where circumcision was not practiced.

In response to the urgent need to reduce the number of new HIV infections globally, World Health Organisation (WHO) and the United Nations AIDS secretariat convened an international expert consultation in March last year to determine whether male circumcision should be recommended for the prevention of HIV infection.

The UN agencies emphasise that male circumcision does not provide complete protection against HIV infection.

It should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counseling.

WHO director of the AIDS department, Dr Kevin de Cock said, "This is an extraordinary development. Circumcision is the most potent intervention in HIV prevention that has been described."

"The recommendations represent a significant step forward in HIV prevention. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment," said Dr de Cock.

Dr de Cock said countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men.

He says scaling up male circumcision in such countries will result in immediate benefit to individuals.

Circumcision has long been suspected of reducing men’s susceptibility to HIV infection because the cells in the foreskin of the penis are especially vulnerable to the virus.

There is now strong evidence from three randomised controlled trials undertaken in Kisumu, Kenya; Rakai District, Uganda (funded by the US National Institutes of Health); and Orange Farm, South Africa (funded by the French National Agency for Research on AIDS) that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 per cent.

This evidence supports the findings of numerous observational studies that have also suggested that the geographical correlation long described between lower HIV prevalence and high rates of male circumcision in some countries in Africa, and more recently elsewhere, is, at least in part, a causal association.