Routine Male Circumcision in Sub-Saharan Africa Could Prevent 6M New HIV Infections, 3M Deaths Over 20 Years, Report Says
Routine male circumcision across sub-Saharan Africa could prevent up to six million new HIV infections and three million deaths in the next two decades, according to a report published in the July 11 edition of PLoS Medicine, Toronto's Globe and Mail reports. The report is based on an analysis of findings from a recent study in South Africa that indicates that male circumcision significantly reduces HIV transmission (Gandhi, Globe and Mail, 7/11). According to the South Africa study, which was published in the November 2005 issue of PLoS Medicine, male circumcision might reduce by about 60% the risk of men contracting HIV through sexual intercourse with women. The randomized, controlled clinical trial enrolled more than 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Half of the men were randomly assigned to be circumcised and the other half served as a control group, remaining uncircumcised. For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. Researchers believed the findings were so significant they deemed it was unethical to proceed without offering the option to all males in the study. Two similar studies examining the effect of male circumcision on HIV transmission currently are underway in Kenya and Uganda (Kaiser Daily HIV/AIDS Report, 6/29).
For the report published Tuesday, researchers looked at data on HIV and male circumcision across Africa and used mathematical modeling to predict the impact of circumcision on HIV transmission over the next 10 years (BBC News, 7/10). The team, which included researchers from the World Health Organization, UNAIDS and universities and research centers in France, South Africa and the U.S., found that if all men in sub-Saharan Africa were circumcised over the next decade, roughly two million new infections and 300,000 deaths could be averted. An additional 3.7 million new HIV infections and 2.7 million deaths could be avoided in 20 years, with one in four of all prevented cases and deaths in South Africa, the study finds (Williams et al., PLoS Medicine, 7/11). The researchers found that the reduced risk of HIV transmission might be related to the structure of the foreskin, which is covered in cells that the virus can infect easily. In addition, the virus' chances of survival might be higher in a warm, wet environment like the one under the foreskin, Reuters U.K.reports (Fox, Reuters U.K., 7/11).
Next Steps, HIV Prevention Implications
The researchers said if the results of the studies in Kenya and Uganda when they are released in mid-2007 are as positive as the South Africa study, advocates might immediately call for a change in HIV prevention strategies. The team said circumcision would have to be promoted in tandem with other prevention methods, including condom use and faithfulness, as well as counseling to emphasize that circumcision will not provide complete protection against HIV. The researchers cautioned that adult male circumcision procedures can be risky, especially if performed by people without proper medical training (Globe and Mail, 7/11). Catherine Hankins, a chief scientific adviser to UNAIDS who cowrote the study, said the researchers need more data from the ongoing trials to further refine the mathematical model that was used. "Safety, acceptability and cost of male circumcision will also be important beyond just modeling this impact, because if you do not get increased uptake you will not see any of these effects," Hankins said. According to BBC News, the reduction in the number of new HIV cases with increased male circumcision would be greatest among men and would then have a "knock-on effect for women" (BBC News, 7/10). UNAIDS is collecting data on circumcision rates and its social acceptability to help nations decide if they want to include circumcision in their HIV prevention efforts, Hankins said (Shimo, Globe and Mail, 7/10). According to acceptability studies conducted in Kenya, South Africa, Uganda and other countries, between 50% and 75% of uncircumcised men would opt to have themselves and their sons circumcised if the procedure was proven to reduce the risk of HIV transmission, Bertran Auvert, who coordinated the South Africa study for France's National AIDS Research Agency, said (Globe and Mail, 7/11).