Health Experts Say Circumcision Could Help Fight AIDS
Charity News Online
Circumcision could be a highly effective way of braking the AIDS pandemic, experts said, cautioning though that before surgeons everywhere reached for their scalpels, major questions had to be answered. Interest in circumcision surged among AIDS researchers last year after a French-funded trial, conducted in South Africa, found that men who had had their foreskin removed were around 60 percent less likely to be infected by HIV than uncircumcised counterparts, AFP reports.
Two similar trials, one in Uganda and the other in Kenya, are currently underway, the 16th International AIDS Conference heard. The trials are due to end in June and September 2007 respectively. If their data confirm the astonishing outcome of the South African trial, the world's top agencies fighting AIDS will move to recommend male circumcision as a method to prevent HIV infection, they said. The UN's World Health Organization (WHO) is already drafting technical recommendations, which could be implemented if circumcision gets the green light.
Advocating circumcision "seems a pretty dramatic thing to suggest, or at least a few years ago it seemed so," said Kevin De Cock, director of the WHO's HIV/AIDS Department, admitting that the South African trial had had a resounding impact. But he also sounded a loud warning, pointing out that circumcision may reduce the risk but was only a partial protection. So it was essential that circumcised men do not become complacent and start to practice unsafe sex in the belief that they could not contract the human immunodeficiency virus (HIV). "It is not a silver bullet," stressed Catherine Hankins, senior advisor to the specialist UN agency UNAIDS.
Hankins also said agencies, governments and doctors had to tread carefully in advising circumcision. In some cultures, circumcision was considered a rite of passage to adulthood and a symbol of manhood; in others, it was considered an emasculation. "In some cultures if you're not circumcised, you are not a man, and in other cultures if you are circumcised, you are not a man. I think it goes very to the heart of masculinity and what that means in the cultures. There are even some anti-circumcision organizations, which are lobbying fiercely against what they call "male genital mutilation," said De Cock.
Scientists started to take a close interest in the circumcision question in the late 1980s, when they realized that in East and West Africa, where the rate of circumcision is high, the rate of HIV infection was low -- whereas in southern Africa, HIV rates were very high but the rate of circumcision was very low: less than 20 percent of men.
The theory behind circumcision's protective effect is that the foreskin has a very thin epithelium, or lining, and easily suffers minor abrasions during intercourse. These microscopic cuts make it easier for the AIDS virus to enter into the man's bloodstream. Another mooted reason is that the foreskin is rich in so-called Langerhans cells whose surface configuration makes it easy for HIV to latch on to them. If circumcision joins condoms in the meager arsenal of weapons to prevent HIV, it could have a mighty effect, according to a study presented at the conference.
Bernar Auvert of the France's National Agency for Research on AIDS, who led the South African trial, said circumcision was a low-cost option: the operation would cost only between 50 and 60 dollars -- less than two months' of the cost of antiretroviral treatment for people who get infected with HIV. But he stressed that circumcision was also a relatively complex operation, lasting around 30 minutes, that had to be carried out under anaesthetic by a surgeon working in hygienic conditions.
A trial funded by the Bill and Melinda Gates Foundation is underway in Uganda to assess whether male circumcision has any impact on the risk of HIV transmission to females.
AIDS, WHO, Bill and Melinda Gates Foundation
Charity News Online
Circumcision could be a highly effective way of braking the AIDS pandemic, experts said, cautioning though that before surgeons everywhere reached for their scalpels, major questions had to be answered. Interest in circumcision surged among AIDS researchers last year after a French-funded trial, conducted in South Africa, found that men who had had their foreskin removed were around 60 percent less likely to be infected by HIV than uncircumcised counterparts, AFP reports.
Two similar trials, one in Uganda and the other in Kenya, are currently underway, the 16th International AIDS Conference heard. The trials are due to end in June and September 2007 respectively. If their data confirm the astonishing outcome of the South African trial, the world's top agencies fighting AIDS will move to recommend male circumcision as a method to prevent HIV infection, they said. The UN's World Health Organization (WHO) is already drafting technical recommendations, which could be implemented if circumcision gets the green light.
Advocating circumcision "seems a pretty dramatic thing to suggest, or at least a few years ago it seemed so," said Kevin De Cock, director of the WHO's HIV/AIDS Department, admitting that the South African trial had had a resounding impact. But he also sounded a loud warning, pointing out that circumcision may reduce the risk but was only a partial protection. So it was essential that circumcised men do not become complacent and start to practice unsafe sex in the belief that they could not contract the human immunodeficiency virus (HIV). "It is not a silver bullet," stressed Catherine Hankins, senior advisor to the specialist UN agency UNAIDS.
Hankins also said agencies, governments and doctors had to tread carefully in advising circumcision. In some cultures, circumcision was considered a rite of passage to adulthood and a symbol of manhood; in others, it was considered an emasculation. "In some cultures if you're not circumcised, you are not a man, and in other cultures if you are circumcised, you are not a man. I think it goes very to the heart of masculinity and what that means in the cultures. There are even some anti-circumcision organizations, which are lobbying fiercely against what they call "male genital mutilation," said De Cock.
Scientists started to take a close interest in the circumcision question in the late 1980s, when they realized that in East and West Africa, where the rate of circumcision is high, the rate of HIV infection was low -- whereas in southern Africa, HIV rates were very high but the rate of circumcision was very low: less than 20 percent of men.
The theory behind circumcision's protective effect is that the foreskin has a very thin epithelium, or lining, and easily suffers minor abrasions during intercourse. These microscopic cuts make it easier for the AIDS virus to enter into the man's bloodstream. Another mooted reason is that the foreskin is rich in so-called Langerhans cells whose surface configuration makes it easy for HIV to latch on to them. If circumcision joins condoms in the meager arsenal of weapons to prevent HIV, it could have a mighty effect, according to a study presented at the conference.
Bernar Auvert of the France's National Agency for Research on AIDS, who led the South African trial, said circumcision was a low-cost option: the operation would cost only between 50 and 60 dollars -- less than two months' of the cost of antiretroviral treatment for people who get infected with HIV. But he stressed that circumcision was also a relatively complex operation, lasting around 30 minutes, that had to be carried out under anaesthetic by a surgeon working in hygienic conditions.
A trial funded by the Bill and Melinda Gates Foundation is underway in Uganda to assess whether male circumcision has any impact on the risk of HIV transmission to females.
AIDS, WHO, Bill and Melinda Gates Foundation
posted by Lisa Vronskaya at 12:39 PM
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