Circumcision curbs HIV: scientists

Research work by the Public Library of Science (PloS) that was conducted in sub-Saharan Africa and released this week elicited that HIV infections in areas where circumcision is common were lower than those where the practice is non-existent.

Countries covered in Southern Africa include South Africa, Zimbabwe, Zambia, Botswana and Swaziland.

According to the research findings, male circumcision if properly done could act as a preventive measure against HIV infection.

“Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa,” says the report.

The report, entitled The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa, over the next 10 years 3.7 million cases and 2.7 million deaths could be avoided. The reduction in the infection rate is estimated at 37 percent. The main beneficiaries of the MC would be men while over time the benefits could extend to the womenfolk.

“Most of the initial impact would be in men, but the reduction in the number of HIV-positive men would in time also lower the risk of women becoming infected. Overall, on the basis of these calculations, male circumcision would reduce the rate of infections by about 37 percent both female-to-male and male-to-female transmission,” states the report.

According to the research findings, the rate of reduction could vary. It would be greatest in Southern Africa where HIV infection rates are high and circumcision rates are low compared with the rest of sub-Saharan Africa. This has been proved by previous researches conducted by other institutions.

For instance, Zambia’s Central Statistics Office says the North Western Province of the country where circumcision is common has the lowest HIV infection rates. More Zambian men, including those from areas where the practice does not take place, are now jostling for circumcision in a bid to elude HIV and AIDS.

The PloS report states that it was noticed some years back that African settings in which circumcision was routinely done on all boys had fewer cases of HIV/AIDS than in areas where it is not tradition.

The report says while male circumcision could have an immediate impact on HIV transmission just like condoms and abstinence, the full impact on prevalence and deaths would only be apparent about 10 to 15 years later because circumcisions averted infections some years into the future among people who on average would have died 10 years later. As everything cannot be rosy, the report also warns of the risks that could go with circumcision.

“There are potential risks in promoting MC as a way of reducing the risk of HIV infection. MC can be performed under poor hygienic conditions, leading to not only infection, bleeding, and permanent injury, but also HIV infection from non-sterilised instruments, and possible death if appropriate treatment of sequelae is not provided,” it cautions.

The other caution is that during the healing period sexually active men are likely to be at a higher risk of HIV infection which should not be underestimated.

“MC does not provide full protection and, if perceived as full protection, could lead to reduction of protection of men who, for example, decrease their condom use or otherwise engage in riskier behaviour,” it further warns.

During the research it was found that the intervention group had significantly more sexual contacts.

The report warns against confusing positive results emanating from MC with female circumcision as the two are totally different.

“Finally, there is the danger of confusing MC with female circumcision, and that promotion of MC could be used by defenders of female circumcision to defend this practice.”

The report says since MC is not a universal cultural practice this could be a barrier in policy considerations.

“However, there are examples showing that the prevalence of MC can be changed. For example, in South Korea 50 years ago, almost no men were circumcised; today some 85 percent of Korean men 16-29 years old are circumcised,” it reassures.

Since time immemorial, male circumcision has been associated with various cultural factors, including religious sacrifice, rites of passage into adulthood, and the promotion of hygiene.

The earliest documentary evidence of circumcision is from Egypt. Tomb artwork from the Sixth Dynasty (2345-2181 BC) shows circumcised men, and one relief from this period shows the rite being performed on a standing adult male.

Genesis (17:11) places the origin of the rite among the Jews in the age of Abraham, who lived around 2000 BC.

Presently, MC practices in Africa are varied. Whereas men in Muslim countries are circumcised, as in North Africa or a large part of West Africa, in other societies the prevalence of MC depends on other cultural factors, such as changes that occurred under colonisation. In countries such as Cameroon and the Democratic Republic of Congo, which are predominately non-Muslim, most men are circumcised .

In Kenya, where only a minority of men are Muslims, men in all tribes except the Luo practice it.

The first paper suggesting a protective effect of MC against HIV infection was published in 1986.

Since then, many observational studies have been published, some of which have found that most men living in East and Southern Africa, the regions with the highest prevalence of HIV, are not circumcised.

According to PloS, many of the observational studies are cross-sectional, and a minority are prospective.

July 2006
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