01 October 2008

Circumcise against HIV: study

The time has come for urgent action to make male circumcision part of the arsenal against HIV transmission, say some of South Africa's leading experts on the disease.

The time has come for urgent action to make male circumcision part of the arsenal against HIV transmission, say some of South Africa's leading experts on the disease.

In an article in the latest issue of the journal Future HIV Therapy, they have rejected claims that calls for circumcision as a prevention strategy are based on incomplete evidence, and premature.

Efficacy well-proven
"As more and more people in sub-Saharan Africa become needlessly infected with HIV, the time has come for urgent and decisive leadership, not circular and unscientific arguments about an intervention whose efficacy has been proven beyond a reasonable doubt," they said.

They drew a parallel between the circumcision debate and other so-called controversial topics, such as the link between cigarette smoking and lung cancer, and between carbon emissions and climate change.

"It is time to move beyond debating the merits of this evidence in professional journals and other legitimate communication outlets and to start implementing effective programmes for safe, voluntary male circumcision and reproductive health in high HIV-prevalence regions," they said.

The World Health Organization (WHO) has pointed out that studies indicate that circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. As a result, the WHO is supporting the rollout of circumcision programmes as part of comprehensive HIV prevention strategies.

Reaching hard-to-reach groups
Male circumcision was a once-off, effective procedure that was unusually culturally acceptable and sought after in many parts of Africa.

It also provided a rare and important opportunity to access a hard-to-reach population - sexually active men at high risk of HIV exposure -with a potentially life-saving intervention combined with behaviour change messages.

The authors of the article include Olive Shisana, Quarraisha Karim, Mark Heywood, Helen Rees and François Venter. Their co-authors are 43 other local and international HIV/Aids experts.

In a statement issued on Wednesday, welcoming the article, the Treatment Action Campaign (TAC) said voluntary male medical circumcision (VMMC) reduced the risk of heterosexual men contracting HIV.

It was highly likely that its widespread introduction in countries with generalised heterosexual epidemics would reduce HIV incidence substantially.

VMMC was however not a magic bullet, and should be part of a comprehensive set of prevention interventions.

TAC said the SA National Aids Council should finalise a national policy on VMMC before the end of the year. – (Sapa)

Read more:
Manto rejects WHO guidelines
Experts call for new HIV strategy

October 2008


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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