Does Circumcision Really Reduce Risk of HIV

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By Wezi Tjaronda WINDHOEK Namibia will adopt a wait-and-see attitude before it can comment on findings that male circumcision reduces by half the risk of HIV infection in men. Clinical trials in Uganda and Kenya, funded by the National Institutes of Health (NIH) on men aged between 18 and 24 in Kenya and 15-49 in Uganda, were stopped by the NIH Data Safety and Monitoring Board (DSMB) because the study revealed an approximate halving of risk of HIV infection in men who are circumcised. In the wake of these results, the World Health Organization and the United Nation AIDS Secretariat will convene a consultation to examine the results of the trials and their implications for countries, especially those in sub-Saharan Africa and elsewhere with high HIV prevalence and low male circumcisions. The results support earlier findings of the South Africa Orange Farm Intervention Trial published in late 2005, which found that there was at least a 60 percent reduction in HIV infection among circumcised men. But the Ministry of Health and Social Services said on Friday it could not comment until these findings to reduce infections among the target group were scientifically proven. Health Permanent Secretary, Dr Kalumbi Shangula, told New Era a number of anecdotal surveys on whether male circumcision reduces HIV infections were ongoing, but none had been proven scientifically. In Namibia, circumcision is part of tradition among the Ovaherero, Ovahimba and Ovambanderu. The joint UN Programme on HIV/AIDS said last week it was anticipated that the results would heighten interest in male circumcision from government, non-governmental organizations and the general public in a number of countries in addition to increasing the demand for male circumcision services. After reviewing the detailed findings, the WHO and UNAIDS secretariat and their partners will define specific policy recommendations for expanding and/or promoting male circumcision. The statement said the recommendations would take into account cultural human rights considerations associated with circumcision, risk of complications from the procedure performed in various settings, the potential to undermine existing protective behaviours and prevention strategies that reduce HIV infection and the observation that the ideal and well-resourced conditions of a randomized trial are often not replicated in other service delivery settings. To support countries that decide to scale up male circumcision services, the joint programme said it is developing technical guidance on ethical, rights-based, clinical and programmatic approaches to circumcision, rapid assessment toolkits to determine circumcision prevalence acceptability, identifying costs and service providers and also monitoring the number of circumcisions performed, their safety and potential impact on sexual behaviour as well as guidance in training, standard setting, certification and accreditation. According to other publications, researchers have noted that parts of west Africa, particularly Muslim countries where circumcision is common, have much lower AIDS rates while those in southern Africa where the practice is less evident have the highest. At the same time, with word about circumcision being protective, other information has it that those southern African men have sought it out. In Zambia, a hospital offered circumcision for US$3 (about N$21) in 2005 while Swaziland had trained 60 doctors to do circumcision after waiting lists had grown at the national hospital.