HIV/AIDS Experts Swear by Circumcision
Saturday, 28 July 2007
Neena Bhandari
Male circumcision could prevent millions of new HIV infections a year, delegates at the 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention were told here on Tuesday.
Over 45 observational studies, three clinical trials and several biological studies all provide compelling evidence that male circumcision reduces HIV transmission from women to men by about 60 percent, according to Prof. Robert Bailey, the lead speaker at a plenary session.
"In the highest prevalence areas, the impact of circumcision would be greatest, and the intervention would be highly cost-effective," said Bailey of the School of Public Health at the University of Illinois.
Estimates from studies show millions of new HIV infections could be averted in sub-Saharan Africa if substantial proportions of men were circumcised. Studies suggest that widespread male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of the disease and 3 million deaths over 20 years.
Bailey, who has devoted most of his research activities on the issue of male circumcision as a possible HIV prevention strategy since 1995, said uncircumcised men were two-and-a-half times more likely to contract the virus from female partners, based on random control trials conducted in parts of Africa, hardest hit by the epidemic.
"There is mounting evidence of its efficacy in preventing new HIV infections. One cannot help but contemplate that if it were a drug or a compound or a shot with a label, international agencies and donors would have been fighting to be the first to make it available many months, even years, ago," says Bailey, who has conducted circumcision-related studies in varying communities in Uganda, Kenya, Malawi, Zambia, as well as in the U.S.
He said the incidents of the disease among heterosexual men could be reduced by up to 9 percent over 10 years, if 50 percent of the men were circumcised in parts of South Africa. "In other words, circumcision could drive the epidemic to a declining state toward extinction, ''Bailey said.
He urged local governments to "make safe, affordable, voluntary circumcision available now." He said younger men would like to get circumcised, but ''the service is not widely available and there is no funding.''
Male circumcision is probably the oldest surgical procedure, dating back to at least 2300 BC in Egypt. Today, about 30 percent of men in the world are circumcised, with about 67 percent of them in Africa.
Circumcision is not just a health-related intervention, it is tied to a complex web of cultural and religious beliefs and practices. Bailey said, ''Studies have shown that women are in favour of circumcision because of improved hygiene. As circumcision becomes more widely accepted through impetus by women, the age of males when they are circumcised will decline. Mothers are going to be major drivers in pushing infant circumcision.''
In a statement issued in February 2007, the World Health Organisation (WHO) and the UNAIDS Secretariat welcomed the detailed findings of two trials undertaken in Kenya and Uganda to determine whether male circumcision has a protective effect against acquiring HIV infection.
The findings of the two trials supported the results of the South Africa Orange Farm Intervention Trial. Together the three studies, which enrolled more than 10,000 participants, provide compelling evidence of a 50 to 60 percent reduction in heterosexual HIV transmission to men.
"These findings are a very important contribution to HIV prevention science. Male circumcision has major potential for the prevention of HIV infection", Kevin De Cock, director of the WHO HIV/AIDS department had said in the statement.
However, the WHO warns that male circumcision does not offer complete protection against HIV. Men should still use condoms, adhere to abstinence, reduce the number of sexual partners and delay the start of sexual activity.
Organisers of the IAS 2007 are calling for greater vigilance to ensure universal access to HIV prevention and treatment, and prolonged research to inform and strengthen the global response to HIV.
IAS president and the conference co-chair Dr Pedro Cahn said, "With fewer than one-third of people living with HIV in low- and middle-income countries having access to life-saving medications, and still fewer with access to proven prevention services, such as condoms and sterile syringes, the goal of universal access by 2010 must remain a priority.''
"Science has given us the tools to prevent and treat HIV effectively. The fact that we have not yet translated this science into practice is a shameful failure,'' added Cahn, who is the Director of Fundación Huesped in Argentina.
Emphasising that "good research drives good policy and programming," the IAS and Australasian Society for HIV Medicine (ASHM) last week issued the Sydney Declaration, a global sign-on letter that urges governments and donors to allocate 10 percent of all resources dedicated to HIV programming for research.
Earlier, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases in the United States and a key adviser to the White House on HIV, told reporters to stop talking about cures for AIDS. He said, ''This is a hugely exciting time in the world of AIDS research. We've got incredibly potent treatments on the horizon, possible vaccines in the pipeline and new options for using these things in ways we haven't before. But as for a cure, let's just stop talking about it."
The U.S. has reported 40,000 annual infections consistently for 14 years. In Australia, the rate has doubled in the past seven years, from 500 annual new infections in 2000 to almost 1,000 in present day.
Some 5,000 delegates from 133 countries will also learn about new knowledge of HIV pathogenesis and the mechanisms through which HIV causes immune deficiency; operations research detailing what we've learned, to date, about what is working on the ground in communities across the globe; and updates on the clinical implications of an ageing population of people living with HIV, as well as on paediatric treatment issues.
......
IPS
Male circumcision could prevent millions of new HIV infections a year, delegates at the 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention were told here on Tuesday.
Over 45 observational studies, three clinical trials and several biological studies all provide compelling evidence that male circumcision reduces HIV transmission from women to men by about 60 percent, according to Prof. Robert Bailey, the lead speaker at a plenary session.
"In the highest prevalence areas, the impact of circumcision would be greatest, and the intervention would be highly cost-effective," said Bailey of the School of Public Health at the University of Illinois.
Estimates from studies show millions of new HIV infections could be averted in sub-Saharan Africa if substantial proportions of men were circumcised. Studies suggest that widespread male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of the disease and 3 million deaths over 20 years.
Bailey, who has devoted most of his research activities on the issue of male circumcision as a possible HIV prevention strategy since 1995, said uncircumcised men were two-and-a-half times more likely to contract the virus from female partners, based on random control trials conducted in parts of Africa, hardest hit by the epidemic.
"There is mounting evidence of its efficacy in preventing new HIV infections. One cannot help but contemplate that if it were a drug or a compound or a shot with a label, international agencies and donors would have been fighting to be the first to make it available many months, even years, ago," says Bailey, who has conducted circumcision-related studies in varying communities in Uganda, Kenya, Malawi, Zambia, as well as in the U.S.
He said the incidents of the disease among heterosexual men could be reduced by up to 9 percent over 10 years, if 50 percent of the men were circumcised in parts of South Africa. "In other words, circumcision could drive the epidemic to a declining state toward extinction, ''Bailey said.
He urged local governments to "make safe, affordable, voluntary circumcision available now." He said younger men would like to get circumcised, but ''the service is not widely available and there is no funding.''
Male circumcision is probably the oldest surgical procedure, dating back to at least 2300 BC in Egypt. Today, about 30 percent of men in the world are circumcised, with about 67 percent of them in Africa.
Circumcision is not just a health-related intervention, it is tied to a complex web of cultural and religious beliefs and practices. Bailey said, ''Studies have shown that women are in favour of circumcision because of improved hygiene. As circumcision becomes more widely accepted through impetus by women, the age of males when they are circumcised will decline. Mothers are going to be major drivers in pushing infant circumcision.''
In a statement issued in February 2007, the World Health Organisation (WHO) and the UNAIDS Secretariat welcomed the detailed findings of two trials undertaken in Kenya and Uganda to determine whether male circumcision has a protective effect against acquiring HIV infection.
The findings of the two trials supported the results of the South Africa Orange Farm Intervention Trial. Together the three studies, which enrolled more than 10,000 participants, provide compelling evidence of a 50 to 60 percent reduction in heterosexual HIV transmission to men.
"These findings are a very important contribution to HIV prevention science. Male circumcision has major potential for the prevention of HIV infection", Kevin De Cock, director of the WHO HIV/AIDS department had said in the statement.
However, the WHO warns that male circumcision does not offer complete protection against HIV. Men should still use condoms, adhere to abstinence, reduce the number of sexual partners and delay the start of sexual activity.
Organisers of the IAS 2007 are calling for greater vigilance to ensure universal access to HIV prevention and treatment, and prolonged research to inform and strengthen the global response to HIV.
IAS president and the conference co-chair Dr Pedro Cahn said, "With fewer than one-third of people living with HIV in low- and middle-income countries having access to life-saving medications, and still fewer with access to proven prevention services, such as condoms and sterile syringes, the goal of universal access by 2010 must remain a priority.''
"Science has given us the tools to prevent and treat HIV effectively. The fact that we have not yet translated this science into practice is a shameful failure,'' added Cahn, who is the Director of Fundación Huesped in Argentina.
Emphasising that "good research drives good policy and programming," the IAS and Australasian Society for HIV Medicine (ASHM) last week issued the Sydney Declaration, a global sign-on letter that urges governments and donors to allocate 10 percent of all resources dedicated to HIV programming for research.
Earlier, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases in the United States and a key adviser to the White House on HIV, told reporters to stop talking about cures for AIDS. He said, ''This is a hugely exciting time in the world of AIDS research. We've got incredibly potent treatments on the horizon, possible vaccines in the pipeline and new options for using these things in ways we haven't before. But as for a cure, let's just stop talking about it."
The U.S. has reported 40,000 annual infections consistently for 14 years. In Australia, the rate has doubled in the past seven years, from 500 annual new infections in 2000 to almost 1,000 in present day.
Some 5,000 delegates from 133 countries will also learn about new knowledge of HIV pathogenesis and the mechanisms through which HIV causes immune deficiency; operations research detailing what we've learned, to date, about what is working on the ground in communities across the globe; and updates on the clinical implications of an ageing population of people living with HIV, as well as on paediatric treatment issues.
......
IPS