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Adult male circumcision can reduce HIV rates

December 13th, 2006

Dr Petra

New research published today suggests that adult men who have circumcisions reduce their HIV rates compared with those who remain uncircumcised.

The trial of men in Kenya and Uganda by the National Institute of Allergy and Infectious Diseases indicated that the men who were offered circumcision as part of a long-term trial were less likely than their uncut peers to develop HIV. The difference in the two groups of men in the trial were so striking the study was halted early because it would have been unethical to continue exposing the uncircumcised men to the risk of HIV without offering them the circumcision option too.

You can read more about the research and related Q&As here.

The researchers are arguing this study indicates a need for a debate on the way HIV is managed and options for curbing the disease. Clearly this is very necessary following these results.

Whilst the study is important I think it still raises a number of ethical and educational issues about sexual health we need to consider.

Firstly, there has to be careful education around this message in case people wrongly assume if they’re circumcised they’ll be immune from HIV which isn’t true. We also need to focus on how to balance messages of condom use alongside advocating circumcision (if this becomes policy). Although this research shows you’ve a reduced chance of getting HIV if you’re circumcised there still needs to be a focus on condom use to ensure people stay safe.

Secondly, in parts of Africa (where these trials took place) circumcision is part of a right of passage that boys go through around puberty or in their mid/late teens. There have been major problems reported recently from countries where this is commonplace because those doing the circumcisions weren’t experienced in doing them, were only doing them for money and haven’t been using clean instruments or which has led to spreading HIV or causing other injuries. Some communities have been very resistant to having such practices carried out within a healthcare setting where infection could be reduced. The news that circumcision can reduce HIV may reinforce in some communities that circumcision is needed and so lead those who seek to make a profit from performing circumcisions to be even more active rather than the procedures being carried out within healthcare settings as this current research advocates.

Thirdly, whilst it was ethical to halt the trial early it appears to have gone straight to public/media rather than been published in any peer reviewed journal which we might have expected for research that seems to be this groundbreaking. I may be wrong about this but haven’t been able to track down the research published outside of the research organisation’s website. It’s clearly an important finding but it seems like there’s a push to get it into policy which might be the right thing to do, but perhaps does need wider debate and consultation within African communities and healthcare.

Finally, Africans have been rightly angered by being told to cut their bodies to prevent the spread of HIV but they look to the West where youngsters are more promiscuous and wonder why we’re not encouraging our kids to be cut. It’s interesting this is being recommended when all the global evidence shows those in the developing world don’t have more sex, they just have a problem with access to healthcare that means health information’s not shared and treatment’s not available.

If adult circumcision is so successful then it should become part of our fight against HIV/AIDS. However, unless we also tackle poverty, gender inequalities and improve healthcare services in Africa and other parts of the developing world, circumcision alone is not enough to halt the spread of HIV.

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