HIV Prevention Funding In Africa Should Be Shifted To Promote Male Circumcision, Partner Reduction Programs, Study Says

Main Category: HIV / AIDS
Also Included In: Sexual Health / STDs;  Men's health
Article Date: 12 May 2008 - 0:00 PDT

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Current HIV prevention strategies have had limited success in fighting HIV/AIDS in Africa and should be shifted to promote male circumcision and partner reduction programs, according to a study published Friday in the journal Science, BBC News reports (BBC News, 5/9). The article was published in a special issue of Science to mark the 25th anniversary of the discovery of HIV, London's Times reports (Henderson, Times, 5/9).

Daniel Halperin of the Harvard School of Public Health, Malcolm Potts of University of California-Berkeley School of Public Health and their eight colleagues wrote that HIV prevention strategies usually involve the promotion and provision of condoms, HIV testing, microbicide research, abstinence and the treatment of other sexually transmitted infections that can increase the risk of HIV, according to an HSPH release.

However, condom promotion has not been effective in parts of Southern Africa because the epidemic is generalized and primarily heterosexual in the region, the researchers wrote. Other studies also have shown that HIV testing and treating STIs have not had a significant impact, they noted (HSPH release, 5/9). "Despite relatively large investments in AIDS prevention efforts for some years now, it's clear that we need to do a better job of reducing the rate of new HIV infections," Halperin said, adding, "We need a fairly dramatic shift in priorities, not just a minor tweaking" (BBC News, 5/9). "The vast majority of donor investments in HIV prevention in the generalized epidemics of Africa continue to go to approaches for which the evidence of actual impact is increasingly unclear," he said, adding, "Many of these approaches ... do have important public health benefits and should be continued, but not because we believe they will definitely have a major impact on reducing HIV infections."

According to Halperin, there is "still some foot dragging on more fully implementing those approaches for which the evidence is much stronger, namely to scale up safe, voluntary male circumcision services and to more assertively promote partner reduction," he wrote (Times, 5/9).

According to the researchers, less than 1% of UNAIDS funding has been allocated for male circumcision programs. They add that other, more costly strategies have been less effective in preventing HIV in the region, London's Independent reports.

Studies have shown that routine male circumcision could reduce a man's risk of contracting HIV by at least 60%, but the procedure also could have benefits for women, according to researchers. "Over time, male circumcision, which has been called a 'surgical vaccine,' would probably protect more women, albeit indirectly, than nearly any other achievable HIV prevention strategy," the researchers wrote.

The added, "Unlike most other interventions, male circumcision is a one-time procedure that confers lifelong protection. Modeling suggests that male circumcision could avert up to 5.7 million new HIV infections and three million deaths over the next 20 years in sub-Saharan Africa, many of these among women."

Potts said, "It is tragic that we did not act on male circumcision in 2000, when the evidence was already very compelling," adding, "Large numbers of people will die as a result of this error" (Independent, 5/9).

Reaction
Michael Carter, spokesperson for Aidsmap said, "There is undoubtedly a growing sense of frustration about HIV incidence figures, and this inevitably leads to the search for methods of prevention that appear more effective." He added, "Circumcision and partner reduction do have a role and will have greater success in some settings than others."

Lisa Power, head of policy at the Terrence Higgins Trust said, "Different strategies are needed for different countries and with the United Kingdom's concentration of HIV in specific populations, targeted work is essential" (BBC News, 5/9).

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