07 June 2007

Mass circumcision for SA?

Local Aids experts have called for a mass circumcision programme, condemning a "deafening silence" from policymakers since studies revealed it sharply cut infection rates.

Aids experts have called for a mass circumcision programme in South Africa, condemning a "deafening silence" from policymakers since studies suggested it sharply cut infection rates.

As scientists this week questioned a lack of movement on using male circumcision as a preventative method, delegates at South Africa's national Aids conference called for the rollout of a mass circumcision programme.

Earlier this year, the World Health Organisation (WHO) recommended the procedure after three studies in Africa showed it reduced chances of contracting HIV by up to 60%.

Nothing done in SA
But although countries such as Kenya, Malawi, Swaziland, Zimbabwe, Mozambique and Tanzania have drawn up plans for widespread circumcision, the South African government has done nothing to date.

"I think by now I would support people starting to think about a mass circumcision campaign," said Neil Martinson of the Perinatal HIV/AIDS research Unit.

Martinson said concerns over whether South Africans thought it was a culturally acceptable practice that would lead to risky sexual behaviour were not proven to be valid.

"In South Africa, high proportions of men and women find it acceptable to be circumcised, people (in the studies) weren't going around and sleeping around more because they didn't have a foreskin."

Focus on prevention
With an Aids vaccine years away, the focus has turned to HIV prevention and the conference aims to build consensus about ways to do this.

"I am surprised there is no action on male circumcision. Where are the male activists? Studies show a 60% reduction (in risk) but there is silence," Glenda Gray, who will oversee the first HIV vaccine trials run in the country, told a panel discussing prevention research.

The primary investigator into the first circumcision trial held in South Africa, Bertran Auvert of the French Institute of Health and Medical Research, told AFP it was time for implementation.

"It's not even my opinion. It's now a WHO recommendation," he said.

The circumcision debate revealed one of the biggest challenges was getting the message across that being circumcised was not foolproof.

In some cultures in South Africa, circumcision is seen as a rite of passage into adulthood, and boys go to initiation schools where they are circumcised with a spear-like instrument.

Don’t rush in
Critics of the mass use of male circumcision to combat HIV, like Tim Quinlan from the University of KwaZulu Natal's Health Economics and HIV/Aids Research Division (HEARD), said there were dangers of jumping into the use of male circumcision without it forming part of a larger package of measures.

He questioned the fact that circumcision only protected men, and not women who were at greatest risk of contracting the virus.

However Professor Alan Whiteside, also based at HEARD, called for the "routine offer of circumcision for every male child born in a public hospital."

"It is so blindingly obvious that there are real reasons for circumcision. It is going to happen. What we need is informed advocacy and communication."

Circumcision involves the removal of the foreskin which contains cells to which the HI-virus clings more readily.

South Africa has the second highest number of HIV sufferers in the world, after India, with some 5.5 million people living with the disease.

A deafening silence
"There has been a deafening silence from policy people in this country, what else should we do, what else is there?" asked Martinson.

"The protective effect is long lasting, it's almost like a vaccine."

He said that research may be needed on how to increase the demand for circumcision.

"Must we target sexual partners, so women say 'I won't sleep with you if you are not cut?" – (Sapa-AFP)

Read more:
HIV/Aids Centre
UN backs circumcision for HIV

June 2007


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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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