Voice of America - October 8, 2007
Howard Lesser
Washington, DC

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Doctors in Rwanda are encouraged by test results in three African countries that show a high correlation between male heterosexual circumcision and a reduction in the transmission rate of HIV/AIDS. Consequently, Rwanda's health ministry says it will promote circumcision through a nationwide education campaign that will reinforce other methods of aids prevention, such as condom use and abstinence. Initially targeting the army, police and students of higher education, the project will receive financial assistance from US President George W. Bush's Emergency Plan for AIDS Relief, known as PEPFAR. Carolyn Williams, PhD, is Chief of the AIDS Division Epidemiology Branch at the US National Institutes of Health's Allergies and Infectious Diseases Institute (NIAID). She explains how the beneficial findings were discovered.

"There were three trials of male circumcision. One was in South Africa, funded by the French, and then two were done by the National Institutes of Health (NIH). Those studies ended in December, and then once the WHO (World Health Organization) had taken some time to look at the results of our trials, then they suggested that male circumcision could be an effective part of a prevention package. So now countries are now beginning to decide how they want to integrate circumcision into their prevention programs," said Williams.

Circumcision trials monitored various groups of African men in three countries with histories of high AIDS infection rates, South Africa, Kenya, and Uganda. One group had the surgery right away, and the other groups in each country waited, in many cases, almost two years before undergoing the procedure. Williams says the results of all three tests, in a French health ministry (INSERM) study in Johannesburg, South Africa, and in American NIH trials in rural Kisumu, Kenya and in Rakai, Uganda, drew nearly identical numbers.

"The trial results in Kenya showed a 53 percent reduction in the risk of getting HIV, and Uganda showed a 48 percent reduction. And then, that was the same as the 50 percent reduction that was seen in the trial in South Africa. And so that raised a lot of interest in the role that circumcision might play as a prevention tool," she noted.

Although evidence has been available for a long time suggesting that male circumcision has helped prevent the transmission of venereal diseases and other infections, epidemiologist Carolyn Williams notes that this is the first time that a surgical procedure has won approval as a deterrent to contracting HIV/AIDS.

"It's been studied for some time that there is an association between lower rates of HIV infection in communities where there is more circumcision. But it's a surgical procedure, very closely tied to cultural reasons why people do and don't circumcise, and it's the first time that we've ever suggested a surgical procedure to prevent an infectious disease. So while male circumcision can be performed safely, and it's not a very difficult surgical procedure, it is a surgery, and there are risks associated with it," she said.

One of the hallmarks of Rwanda's promotion of heterosexual male circumcision will focus on a nationwide education campaign, which will receive financial assistance from the Bush Administration's PEPFAR (President's Emergency Plan for AIDS Relief) initiative. Carolyn Williams explains that since the World Health Organization has endorsed male circumcision as an HIV preventive measure, the PEPFAR initiative will be supporting countries that want to make male circumcision part of their prevention program.

"Starting in 2007, countries can apply for funding to include male circumcision services. And now, the National Institutes of Health is working with the World Health Organization, and they are helping to guide ministries of health if they develop the programs that would be necessary to actually offer male circumcision around the world," she noted.

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