AIDS Experts Call For Mass Male Circumcision In South Africa

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Main Category: HIV / AIDS
Also Included In: Public Health;  Pediatrics / Children's Health
Article Date: 08 Jun 2007 - 0:00 PDT

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AIDS experts have called for mass male circumcision in South Africa. Yesterday's proceedings of the country's third national AIDS conference held in Durban was dominated by a heated debate on whether a mass circumcision programme should be introduced to fight the country's growing AIDS crisis.

Over 5 million South Africans now have HIV, that is one person in nine.

Professor Alan Whiteside, who is director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal, said that circumcision should be routine for all baby boys born in public hospitals, unless their parents objected.

And adult men who want the procedure should be offered it under medical aid schemes, he said.

Neil Martinson, the deputy director of the Perinatal HIV Research Unit in the University of Witwatersrand in Johannesburg, said there was now a lot of evidence showing that male circumcision was so effective that it was "almost like a vaccine".

Circumcision is already common in many South African communities, and many men and women find it acceptable, said Martinson.

However, some critics say that mass circumcision does not help women, does not discourage multiple partners, and could even encourage men and women to take risks thinking that circumcision conferred immunity and removed the need for condoms.

However, according to Martinson, research showed otherwise. Circumcised men were not "sleeping around more" he said.

Studies, which were halted early last year in order to publish the results, showed that male circumcision reduced HIV infection rates by up to 60 per cent.

This figure was not enough to justify the cost of a mass circumcision programme, suggested Timothy Quinlan, research director at HEARD. Scientists would expect a higher rate than 50 or 60 per cent to justify such a programme. It would be OK if it was the only option, but the money would be better spent on a "whole host of other ways to prevent HIV", he said.

Whiteside's view is that circumcision will happen, and the focus now should be on how to make it effective.

"We need clear, informed advocacy and communication," he said.

The conference's opening day was marked by a note of optimism, with several speakers noting the progress that has been made in South Africa's fight against HIV and AIDS.

For instance, Dr Peter Piot, head of the Joint United Nations Programme on HIV/AIDS (UNAIDS), praised the country's "remarkable progress" in antiretroviral treatment and its ambitious National strategic Plan, saying that if the plan is achieved, South Africa would be leading the way in fighting AIDS in Africa.

However, he, and other speakers, said the real work was only just beginning.

Much of the evidence supporting the case for male circumcision as a way to help African countries to stem the AIDS epidemic came from two large randomized studies in sub-Saharan Africa and Uganda, published in the Lancet that showed up to 60 per cent reduction in the rate of HIV infection in men after circumcision.

Previous non-randomized epidemiological studies had already suggested that uncircumcised men were at higher risk of HIV infection after sexual intercourse and this could be due to the fact the foreskin contains soft non-keratinized tissue and cells that are more vulnerable to the virus.

Click here for the Official Website of the 3rd South African AIDS Conference.

Click here for more information on situation analysis on AIDS in South Africa (from UNAIDS).

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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