Circumcision cuts HIV risk
Taurus
03-29-2007, 02:07 PM
[img2=left]http://www.gayspeak.com/forum/images/news/scissors.jpg[/img2]Two studies which circumcised adult men in Africa as a way of preventing HIV have been stopped early because the results were so good that it was decided it was unethical not to offer circumcision to everyone.
The news was greeted with an unusually high-powered joint statement from the UN AIDS programme UNAIDS, the World Health Organisation (WHO), the World Bank, the UN Population Fund and UNICEF saying that they note the results with "considerable interest".
They add: "It is anticipated that these results will heighten interest in male circumcision from governments, non-governmental institutions and the general public in a number of countries."
The UN agencies said they would rapidly convene a consultation to look at the practicability of mounting widespread circumcision programmes in countries with high rates of HIV.
They also hinted that they’d like to see a study conducted among gay men.
A WHO team have already travelled to Jerusalem to get Israeli advice on safe circumcision programmes in adults, because many Jewish immigrants who were not circumcised in their home country get the operation when they settle in Israel.
The two trials took place in an urban population of 3000 men aged 15-24 in Kisumu, Kenya and in a rural population of 5000 men in Rakai Province, Uganda. They compared HIV infection rates in men who were circumcised and ones who were not.
In Kisumu there was a 53% reduction in HIV infection among the circumcised men – 22 got HIV compared with 42 who were uncircumcised – and in Rakai the reduction was 48%.
These results are not quite as good as a South African study which in 2005 found a reduction of 65% among circumcised men – but they are still impressive.
The UN statement notes that there is an ongoing study in Rakai to see if circumcision also reduces the risk to the female partner, with results due in 2008. Earlier population surveys found that it might reduce the risk to women of acquiring HIV by 30%.
They add: "The effect of male circumcision on reducing the risk of HIV transmission among men who have sex with men has not been studied in a randomised controlled tria" – a clear hint that they’d like to see one done.
The UN press statement warns that circumcision does not provide complete protection against HIV infection, and that "it should always be considered part of a comprehensive HIV prevention package" which includes condoms, fewer partners, delaying the date of first sex, and HIV testing programmes.
They warn that if circumcised men develop a "false sense of security" and start taking up high-risk behaviour again, it could "negate the effect of…circumcision."
However the Kisumu researchers recently released another paper in which they found no evidence that circumcised men had more high-risk sex than uncircumcised ones for up to a year after the operation.
The UN is also concerned about the cultural acceptability of circumcision, and in making sure the operation is performed safely. They are developing detailed policy guidelines on making sure circumcision isn’t forced on people, that the risk of complications is properly researched and explained, and that there is ongoing research to find if it alters sexual behaviour.
"This is very exciting news", Daniel Halperin of the Harvard Center for Population and Development told the New York Times.
"I have no doubt that as word of this gets around, millions of African men will want to get circumcised, and that will save many lives."
The news was greeted with an unusually high-powered joint statement from the UN AIDS programme UNAIDS, the World Health Organisation (WHO), the World Bank, the UN Population Fund and UNICEF saying that they note the results with "considerable interest".
They add: "It is anticipated that these results will heighten interest in male circumcision from governments, non-governmental institutions and the general public in a number of countries."
The UN agencies said they would rapidly convene a consultation to look at the practicability of mounting widespread circumcision programmes in countries with high rates of HIV.
They also hinted that they’d like to see a study conducted among gay men.
A WHO team have already travelled to Jerusalem to get Israeli advice on safe circumcision programmes in adults, because many Jewish immigrants who were not circumcised in their home country get the operation when they settle in Israel.
The two trials took place in an urban population of 3000 men aged 15-24 in Kisumu, Kenya and in a rural population of 5000 men in Rakai Province, Uganda. They compared HIV infection rates in men who were circumcised and ones who were not.
In Kisumu there was a 53% reduction in HIV infection among the circumcised men – 22 got HIV compared with 42 who were uncircumcised – and in Rakai the reduction was 48%.
These results are not quite as good as a South African study which in 2005 found a reduction of 65% among circumcised men – but they are still impressive.
The UN statement notes that there is an ongoing study in Rakai to see if circumcision also reduces the risk to the female partner, with results due in 2008. Earlier population surveys found that it might reduce the risk to women of acquiring HIV by 30%.
They add: "The effect of male circumcision on reducing the risk of HIV transmission among men who have sex with men has not been studied in a randomised controlled tria" – a clear hint that they’d like to see one done.
The UN press statement warns that circumcision does not provide complete protection against HIV infection, and that "it should always be considered part of a comprehensive HIV prevention package" which includes condoms, fewer partners, delaying the date of first sex, and HIV testing programmes.
They warn that if circumcised men develop a "false sense of security" and start taking up high-risk behaviour again, it could "negate the effect of…circumcision."
However the Kisumu researchers recently released another paper in which they found no evidence that circumcised men had more high-risk sex than uncircumcised ones for up to a year after the operation.
The UN is also concerned about the cultural acceptability of circumcision, and in making sure the operation is performed safely. They are developing detailed policy guidelines on making sure circumcision isn’t forced on people, that the risk of complications is properly researched and explained, and that there is ongoing research to find if it alters sexual behaviour.
"This is very exciting news", Daniel Halperin of the Harvard Center for Population and Development told the New York Times.
"I have no doubt that as word of this gets around, millions of African men will want to get circumcised, and that will save many lives."
Note: No trees were destroyed in the sending of this contaminant free message. However, I do concede, a significant number of electrons may have been inconvenienced.
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