A Question of the Cutting Edge: Male Circumcision & HIV

Masimba Biriwasha

Editor's Note: Today we welcome Masimba Biriwashi, a Zimbabwean writer and journalist, writing from Thailand. He has experience with Health & Development Networks and will be covering HIV/AIDS issues on the continents of Africa and Asia.

Male circumcision (removal of the foreskin of the male penis) is increasingly gaining currency as an alternative method to reduce HIV-infection. In sub-Saharan Africa, the worst affected region in the world, male circumcision (MC) could prevent six million new infections, researchers say.

Editor's Note: Today we welcome Masimba Biriwashi, a Zimbabwean writer and journalist, writing from Thailand. He has experience with Health & Development Networks and will be covering HIV/AIDS issues on the continents of Africa and Asia.

Male circumcision (removal of the foreskin of the male penis) is increasingly gaining currency as an alternative method to reduce HIV-infection. In sub-Saharan Africa, the worst affected region in the world, male circumcision (MC) could prevent six million new infections, researchers say.

In fact, evidence from observational studies in sub-Saharan Africa has shown that circumcised men have a lower risk of acquiring HIV infection than uncircumcised men. A study in South Africa showed that male circumcision might reduce by about 60% the risk of men contracting HIV through sexual intercourse with women. The study focused on 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Of these, half were randomly selected for circumcision while the other half remained uncircumcised and served as a control group.

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.

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The argument is that the inner surface of the foreskin contains Langerhans celles, which have HIV receptors, and is also vulnerable to traumatic epithelial disruptions during intercourse. Second, an intact foreskin exposes a man to a greater risk of ulcerative sexually transmitted infections, which in themselves are a risk factor for HIV acquisition. Furthermore, the virus' chances of survival might be higher in a warm, wet environment like the one under the foreskin.

The evidence that circumcision may protect against HIV infection is now considered strong enough that trials evaluating the efficacy of transmission as part of an HIV prevention program have been advocated. This could herald a new era in HIV-prevention methods.

According to USAID, qualitative studies in Botswana, Haiti, Tanzania, Zambia, and Zimbabwe have revealed favorable attitudes toward MC in populations that do not traditionally practice circumcision. From 45 to 85 percent of uncircumcised men in surveys have expressed interest in the procedure if it is safe and affordable.

In spite of the interest in male circumcision, it is not a magic bullet in the fight against HIV/AIDS. To be effective, circumcision has to be promoted alongside condom use and faithfulness, traditional approaches in the fight against HIV and AIDS.

Some men may be tempted to engage in unprotected sex because they perceive they are protected by male circumcision. In itself, male circumcision provides little or no protection against urethral STDs such as gonorrhea and chlamydia and certainly cannot prevent unwanted pregnancies.

To be successful, male circumcision will have to be complemented by a massive investment into education and counseling programs. There will be need for widespread and culturally sensitive dissemination of information that outlines the benefits and potential complications of male circumcision.

Another danger is that male circumcision can be risky or fatal if conducted by untrained personnel. Most health facilities in sub-Saharan Africa are in a shambles, putting great doubt on the efficacy of male circumcision.

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