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Male circumcision drive falls short in Africa - AIDS campaigners

Source: Thomson Reuters Foundation - Wed, 25 Jul 2012 10:56 PM
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WASHINGTON (AlertNet) - Male circumcision is failing to make the cut in many African countries where instances of HIV/AIDS are high, despite a push by international agencies over the past five years to promote the surgery as an important method for lowering the risk of HIV transmission from women to men.

Chances of reaching a target of getting 20 million adult men in 14 sub-Saharan countries circumcised by 2015 to halve the spread of HIV/AIDS are receding, according to AVAC, a global advocacy group for HIV prevention. 

Cultural and religious barriers and a lack of funding are holding back progress in reaching the goal, it said, even though clinical studies have shown that circumcised men are 60 percent less likely to contract the HIV virus from an infected woman during heterosexual sex.

Only Kenya has made significant strides and is halfway toward its goal. On average the 14 countries are 8 percent of the way toward getting 80 percent of adult males between the ages of 15 and 49 circumcised, AVAC said in its study.

Achieving the goal would reduce new HIV infections by 20 percent by 2025 and save $16.6 billion in future medical costs, the World Health Organization and UNAIDS have estimated.  

“At this moment in the epidemic, there are few things that could do more to reduce the human and economic toll of HIV,” said Mitchell Warren, executive director of AVAC, which joined with other advocacy groups and international agencies at the 19th International AIDS Conference to press for male circumcision programs.

“We need to refocus on this inexpensive, one-time intervention that offers men life-long partial protection against HIV,” Warner said. 

Dr. Robert Bailey, a leading proponent of the surgery, told a seminar at the conference that a new study tracking 2,784 men who underwent the procedure in Kenya’s Kisumu Province has found that the female-to-male HIV infection rate was reduced by between 54 percent and 65 percent, depending upon how the results were calculated.

This finding confirmed results of three earlier studies and adds further support to continuing voluntary programmes for adult men in communities hit by high rates of HIV and where circumcision rates are low, Bailey said.

But male circumcision - practised widely amongst Muslims, Jews and in many African communities as a right of passage - invites considerable controversy, even though about one-third of all men world wide are circumcised.

Opponents say the practice violates human rights, squanders scarce resources, distracts from more effective HIV prevention methods and promotes a false sense of security when in fact a circumcised man still needs to use a condom to be protected against the HIV virus.

A German district court has caused a storm by banning the practice on young boys, saying it inflicts bodily harm, although it did rule that it could be practiced on older men who give their consent. The German parliament is considering a special exemption to avert criticism of religious discrimination.

At the AIDS conference, attended by over 20,000 people from all over the world, placards held by protestors outside read: “Intact Genitals – A Human Right” and decried the practice as a form of torture that decreases sexual pleasure and does little to address the AIDS epidemic.

“Men in the United States were circumcised and it didn’t stop the spread of HIV/AIDS. Men in Scandinavia aren’t circumcised and they don’t have the AIDS epidemic,” said David Wilson from SICSociety, which stands for Stop Infant Circumcision.  

UNAIDS and the World Health Organization have recommended that countries with high levels of HIV roll out voluntary male circumcision programmes as part of their arsenal, though they make clear it should be combined with other methods - expanded HIV testing, education and condom programmes, maternal programmes to prevent mother to child transmission, and antiretroviral drug therapies.  

Bernhard Schwartlaender, director of strategy at UNAIDS, said “it would have quite dramatic results” if new HIV infections now running at 2.4 million annually could be reduced by 50 percent to 60 percent from male circumcision.

Moreover, it is a one-time cost for the procedure, and it is cheap at roughly $1, he said.

Physicians from Rwanda and Kenya presented studies at the conference on new surgical techniques that make the operation quicker, safer and cheaper to perform and in some cases less painful.

Male circumcision entails removing the foreskin of the penis to prevent bacteria accumulating under its folds. The traditional method is by surgical cutting, a procedure done under local anesthesia that takes about 20 minutes to perform, and then stitches are inserted. New methods include inserting rings around the penis, which allows the foreskin to wither without the need for stitches. Recovery time takes about 33 to 45 days.

The countries targeted by UNAIDS and the World Health Organization are Uganda, Rwanda, Zambia, Namibia, Botswana, South Africa, Ethiopia, Kenya, Tanzania, Malawi, Zimbabwe, Mozambique, Swaziland and Lesotho.

Leadership is critical to winning public support for male circumcision and countries where high-profile public figures advocate the procedure make faster progress, AVAC said.  In Tanzania, former President Benjamin Mkapa is a campaigner.

“Scaling up this intervention is an urgent priority,” he said. “Although it means an upfront investment, the results are significant long-term cost savings.” 

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