Voice of America - December 13, 2006
David McAlary
Washington

Two long awaited studies from Africa show that a man's risk of getting the AIDS virus heterosexually is cut in half if he is circumcised. As we hear from VOA's David McAlary in Washington, public health experts say circumcision can be a new weapon in the anti-HIV arsenal.

Many studies have suggested that male circumcision protects against HIV, but two new ones from Kenya and Uganda provide the strongest evidence so far.

The Kenyan trial of 2,700 HIV-negative men aged 18 to 24 shows that circumcision reduced their risk of AIDS from heterosexual intercourse by 53 percent.

The parallel Uganda study of 5,000 HIV-negative men aged 15 to 49 shows a similar result - a 48 percent reduction in risk. They confirm a French government study in South Africa last year showing that circumcision confers a 60 percent lower risk of HIV infection during heterosexual sex.

The findings are so strong that the U.S. government agency sponsoring the trials, the National Institute of Allergy and Infectious Diseases, halted them several months early so the uncircumcised men in them could take advantage of the procedure.

Dr. Anthony Fauci, the agency's director, said, "If you look at the data, they are very powerful."

"It is quite impressive, the effect of circumcision on decreasing the incidence of HIV infection," he continued.

Fauci and other public health officials hail the results as a potentially powerful way to reduce HIV infections in Africa.

Physician Willard Cates, head of research at Family Health International, a U.S. non-governmental organization working to improve health care in developing countries, said, "We will have another new tool available for prevention."

At the World Health Organization, the head of its HIV/AIDS Department, Dr. Kevin DeCock, says male circumcision has the potential to prevent perhaps millions of infections in the coming years.

But he warns that the procedure is not completely protective.

He said, "This must not reduce our emphasis on other preventive interventions - behavioral interventions, regular and consistent use of condoms."

Willard Cates at Family Health International calls for prompt action by the global community to support expanded access to safe, voluntary male circumcision services.

DeCock says the World Health Organization will convene a meeting very early in the new year among the researchers, the donor community, and other partners to discuss the public policy implications of the findings.

He said, "We're at the very important point of beginning translation of these findings into policy and then potentially into practice."

But Willard Cates says expanding access to safe male circumcision services could run into several complications in poor countries, which he lists.

"Deficiencies of health systems in Africa, cultural barriers to acceptance of circumcision as a prevention tool, and the limited number of trained medical providers in the countries where the intervention might hold the most promise," he said.

Cates says overcoming such barriers will require focused attention.

Experts say the prevalence of male circumcision in sub-Saharan Africa varies widely. In some areas, nearly all men have not had it.

But the director of the World Bank's Global HIV/AIDS Program, Debrewerk Zewdie, says it is becoming more acceptable in southern African countries that are among the hardest hit by the epidemic.

"Most of the southern African countries, Lesotho being a very good example, are going to go into mass circumcision," she said. "That's very good on the one hand, but we need to be very careful that we get this right."

For Zewdie, getting it right means safe male circumcision by trained medical providers to keep complication rates down.

The U.S. and African researchers who conducted the two studies found that traditional circumcision led to complication rates of 34 percent in Kenya and 18 percent in Uganda. By comparison, complication rates in the carefully conducted studies were very low - less than two percent.

Like Debrewerk Zewdie, Anthony Fauci foresees male circumcision gaining wider acceptance.

He said, "So although it was a little bit late in coming, I think the enthusiasm for it is mounting, to the point where it will assume its appropriate role as one of the major components of preventive measures."

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