08 Aug 2006: ISS Today: `Promoting Voluntary Circumcision under Safe, Hygienic and Human Rights Sensitive Conditions`. Highlights towards the run up t

08 August 2006: “Promoting Voluntary Circumcision under Safe, Hygienic and Human Rights Sensitive Conditions”
Highlights towards the run up to the XVI International AIDS Conference, 13-18 August, Toronto, Canada

 

On Sunday, 13 August the XVI International AIDS Conference opens. In the interests of Sub-Saharan Africa, and especially the Armed Forces in Southern Africa, we need to highlight one of the most dramatic, cheap and cost effective methods of reducing the spread of HIV and AIDS – male circumcision – which is detailed in the report, “The Potential Impact of Male Circumcision (MC) on HIV in Sub-Saharan Africa” (1). Emerging from the most reliable clinical research initiatives [randomised control trials (RCT)] conducted in 2005 and 2006 on male circumcision (MU), the World Health Organization (WHO) and UNAIDS, together with internationally renowned Centres of Infectious Diseases in the United States, Europe, as well as the Southern African HIV Clinical Society, have all agreed that this drastically reduces transmission of HIV from women to men by as much as 75%.

 

This statistic is significant in several respects: currently, the largest mode of transmission of HIV is through heterosexual intercourse and MC would directly respond to this aspect. Secondly, this then has important implications for the potential infection of women by males in Sub-Saharan Africa, a region in which males dominate the decisions taken around sexual intimacy. Thirdly, we believe that MC has also partly already contributed to the low rates of HIV prevalence in Moslem dominated West and Central Africa where this practice is embedded in the region’s culture.

 

The mathematical modelling on predictions surmise that if MC was undertaken in sub-Saharan Africa, it would avert over 6 million of new HIV infections while preventing 3 million deaths over the next twenty years. Given the extended impact of reduced infections in young girls, the projected figures would continue to rise towards the 30-year mark. Investigations by the French National Research Agency( INSERM) in South Africa are more specific, suggesting the saving of 1:4 South Africans from the effects of the epidemic.

 

Southern Africa is the epicentre of the global epidemic of HIV/AIDS and yet grasping the message coming from the cost effective, cheap and reliable MC clinical investigations appears not to have registered. Available preliminary evidence of nationwide MC campaigns shows that it is only Swaziland and Zambia where UNAIDS have quickly moved to provide technical support for hygienic, voluntary medical/clinical support. Meanwhile, in Botswana, Uganda, Lesotho and Tanzania, “officials are still contemplating” whether or not to implement the MC initiative. Given the radical nature of the success of the research so far, this paper calls for the urgent adoption of MC by the region’s Armed Forces, who may then act as change agents for the rest of the males in their societies to undergo similar operations. The benefit for both sexes is almost assured, cognisant of the fact that this is only but one dimension of the comprehensive combat against HIV and AIDS.

 

Martin Rupiya

1. http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0030262