Circumcision could halt 4 million new African HIV cases

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More than 4 million new HIV infections could be prevented in eastern and southern Africa by 2025 if male circumcision rates were increased to 80 percent, researchers said on Tuesday.

Expanding circumcision services to 80 percent of adult and newborn males in the region would also save $20.2 billion in HIV-related health costs between 2009 and 2025, they said.

“With global resources spread thin, we must focus on expanding proven and cost-effective methods like male circumcision to prevent HIV transmission,” Krishna Jafa, an HIV expert at health aid group Population Services International (PSI), said at an AIDS conference in Vienna.

Jafa’s comments echoed former U.S. President Bill Clinton and philanthropist Bill Gates, who both used speeches to the conference to call for rapid scale-up of male circumcision as a cost-effective way to prevent the spread of HIV.

Sub-Saharan Africa carries the greatest burden of the human immunodeficiency virus (HIV) that causes AIDS, accounting for 67 percent of the 33.4 million people living with the virus worldwide. An estimated 1.9 million people were newly infected with HIV in the region in 2008.

Research cited by the World Health Organisation has shown that male circumcision can reduce a man’s risk of getting HIV by up to 60 percent.

PSI presented results of a study from Zimbabwe, where researchers designed and tried out an efficiency model called MOVE, aimed at increasing the numbers of male circumcisions by using better techniques, training, equipment and staff.

In a pilot of the new system, a team of two doctors and three nurses was able to carry out four circumcisions at the same time and increase their rate from three operations per hour to 10, the results showed. Over 12 months of the pilot, around 6,500 men were circumcised.

The findings also showed the quality of the procedure was not compromised and there were no increases in the percentage of men reporting bad side effects afterwards.

In March 2007, the WHO and United Nations UNAIDS group recommended male circumcision as an effective HIV prevention.

The PSI study found that in Zimbabwe alone, which has an adult HIV rate of 13.7 percent and a male circumcision rate of just over 10 percent, 750,000 new HIV infections could be prevented if 80 percent of men were to be circumcised. It also found there was high demand for the procedure.

Bill Gates, whose Gates Foundation spends much of its $34 billion fund on fighting HIV, told the AIDS conference on Monday he had been surprised by the number of men in Africa who wanted to be circumcised to reduce their risk of contracting HIV.

“I was doubtful that a large number of men would sign up for it. I’m glad to say I was wrong,” he said. “Wherever there are clinics available, men are volunteering to be circumcised in huge numbers - far more than I expected.”

But Gates said while more than 41 million men in sub-Saharan Africa could benefit from it, only 150,000 have been circumcised in the past few years.

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By Kate Kelland

VIENNA (Reuters)

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Bill Gates may be surprised but I’m not. Men are signing up because they imagine circumcision will make them personally immune, not just increase “herd immunity”. They are going to throw caution to the winds. This is a recipe for disaster. In three trials, they circumcised a total of 5,400 men and left a similar group intact. After less than two years, 64 of the circumcised men and 137 of the intact men had HIV. That difference, 73 circumcised men who didn’t get HIV, is the whole basis of the claim that “More than 4 million new HIV infections could be prevented”. It is known that studies cut short “for benefit” as these all were, are more likely to show benefit. 327 circumcised men, and a comparable number of non-circumcised men, left the trials, their HIV status unknown. That is easily enough for the 73-man difference to be non-significant. Circumcised men who found they were HIV+ would leave because the trial had let them down. Non-circumcised men would leave because they had decided they didn’t want to get circumcised - perhaps after talking to the circumcised men. The trials were neither double blinded nor placebo controlled, the true gold standard of clinical trials. In 2005-6, 20% of circumcised Zimbabwean men had HIV, and “only” 19% of non-circumcised men. Similar ratios hold in at least six other African countries according to the National Health and Demographic Surveys. In Malaysia, where 60% of the population is Muslim (and virtually all Muslim men are circumcised and hardly anyone else), 72% of new HIV infections are of Muslims. That certainly needs to be explained before pressing ahead with mass circumcision campaigns.

posted by Hugh Young on 07/21/2010 at 1:54 pm -08:00