Can male circumcision lower risk of HIV/AIDS?By MELISSA DASSRATH Sunday, August 3 2008
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Social Development Minister Dr Amery Browne...
Despite convincing scientific evidence which supports that adult male circumcision drastically reduces the risk of contracting the HIV/AIDS virus, many countries including Trinidad and Tobago have hesitated to implement it as a viable solution to stop the spread. Instead, governmental agencies and NGO’s continue to promote protected sex as the most effective safeguard.
AIDS is, by far, the worst epidemic modern man has had to endure because it breaks down our body’s immune system which is designed to defend us from disease.
It seems that we are fighting a losing battle against the rampant disease because, in spite of preventative campaigns, the pandemic continues unabated.
The philosophy that prevention is better than cure is behind the “ABC” approach to fighting HIV/AIDS that advocates “abstinence, be faithful and use condoms”. The “ABC” approach has proven to be a weak attempt to curb the HIV infection rate.
In 2007, an estimated 33.2 million patients lived with the disease worldwide while an estimated 2.1 million people died from the disease. Over three-quarters of these deaths occurred in Sub- Saharan Africa. AIDS continues to be the single largest cause of mortality in the region, accounting for 76 percent of all deaths.
Southern Africa (including South Africa, Botswana and Swaziland) also has the largest population of people living with HIV/AIDS in the world. In 2007, 68 percent of the people were living with HIV/AIDS, with 1.7 million new infections bringing the number of people living with disease to 22.5 million.
But, new research coming out of the continent hardest hit by the effects of HIV/AIDS suggests that circumcision significantly reduces the risk of infection for men by roughly two-thirds and that infected men can reduce the odds of transmitting the virus to their partners by about 30 percent.
Although previous studies have linked circumcision with an increased risk of HIV infection, new research shows that the cells on the underside of the foreskin are prime targets for the virus and that tears and abrasions in the foreskin can invite the infection.
According to researchers, the skin on the glans of the circumcised penis is tougher than that of the foreskin and can substantially stave off the virus.
A random study was conducted on more than 3,000 HIV-negative South African men between ages 18 to 24. The men were again randomly selected into two groups, half of the men were circumcised while the other half remained uncircumcised.
After almost a year, the data indicated that for every ten uncircumcised men in the study who became infected with HIV only an estimated three circumcised men contracted the virus.
After discovering the dramatic results, the French and South African researchers reportedly halted the study for about nine months in order to offer the uncircumcised men the opportunity to undergo the procedure.
However, HIV/AIDS is not an isolated problem and the question of whether the reported findings can be generalised to other countries with different cultures as a method of prevention has yet to be debated. How this strategy would specifically translate in Trinidad and Tobago to reduce the rate of infection is another issue.
HIV/AIDS was first diagnosed in Trinidad and Tobago in 1983. Since then, over 27,000 are estimated to be living with HIV/AIDS. Almost 50 percent of all new infections are reported among persons in the 15-24 age group.
Beyond these statistics, the actual number of unreported cases of people living with HIV/AIDS is estimated to be higher.
Dr Michel De Groulard is the Regional Programme Advisor and Acting Regional Director of The Joint United Nations Progamme on HIV/AIDS (UNAIDS) in Trinidad. The French native graduated with a doctorate in medicine and specialised in public health and epidemiology.
In spite of strong evidence in support of circumcision as a preventative method, De Groulard is doubtful that it would effectively reduce the risk of contracting the virus and recommends condom use.
De Groulard explained, “The results of the study is problematic. It’s not true that it reduces the probability of becoming infected with HIV. Circumcision will only reduce the risk of passing the virus from a woman to a man, but not from a man to a woman. It protects the inserting partner, but not the receiving partner.”
He clarified that circumcision has been found to equally reduce the risk of HIV transmission in both heterosexual and homosexual intercourse.
De Groulard stated that the research findings are positive but not foolproof, “The study shows a reduction in the risk of transmission of the disease in circumcised men by 50 percent.
“This is something we need to take note of, but it does not mean that circumcised men are 100 percent protected from HIV/AIDS. So men, whether circumcised or uncircumcised, should continue condom use.”
He noted that last week UNAIDS launched the Global Report which is published every two years just before the International AIDS Conference. The Global Report is a comprehensive document compiled from full reports submitted by each of the 192 member nations with detailed data about each country’s response to combat the AIDS epidemic.
That report acknowledges the growing importance of medical male circumcision in HIV risk reduction amongst men.
Andrew Fearson, the Financial Management Officer of the National Aids Coordinating Committee (NACC), indicated that the National Strategic Plan (NSP) is currently being reviewed.
“The NSP is still in the development process so we will be considering all of the available evidence in support of prevention and treatment. There is a chance that circumcision is something that might be considered. But Cabinet has the final decision on which policies are implemented,” he said.
The five-year NSP will outline a tactical approach with the goal of “reducing the incidence of HIV infections in Trinidad and Tobago” and “mitigating the negative impact of HIV/AIDS on persons infected and affected in Trinidad and Tobago” for the next five years. The estimated budget for the 2004-2008 NSP was US$90.33 million (TT$584 million).
Social Development Minister Dr Amery Browne has indicated that he is aware of a number of studies that link male circumcision to a reduction in the transmission of HIV/AIDS from female to males.
However, he expressed the view that the validity of the results warrant further analysis before it can be implemented as a viable option in the fight against AIDS.
“There is an emerging body of important information, but our country is not at the stage where it can be implemented into policy of prevention.
“For instance, UNAIDS has not yet made specifications for a generalised programme. So while this information is useful to help individual adult males, a decision that would impact males on a national level would be premature. There is certainly a need for more analysis,” the Minister said.
Browne also noted that the results of this sort of study must be “taken with a grain of salt” and warned people to err on the side of caution: “There is always a danger with this kind of news that people will become complacent.
“Circumcision does not mean that you are immune to AIDS. People still need to be cautious and practice safe sex.”
Community Action Resource (CARe) is a non-governmental support organisation that offers services such as counselling and group therapy for people living with HIV/AIDS; they also conduct workshops to educate the public about prevention.
CARe’s Programme Advisor Catherine Williams explained, “We have been teaching people about how circumcision reduces the risk of infection. With men who are not circumcised, the foreskin folds over the head of the penis.
Smegma is a secretion by the glans of the foreskin. Smegma can build up underneath the foreskin and bacteria can accumulate and transfer between partners. So there is an increased risk of infection for STDs or HIV/AIDS. Circumcision would protect both partners from chances of contracting diseases.”
She refuted the misconception that circumcision has a strictly religious meaning, “It’s not just a Jewish or Islamic practice, but it’s a matter of hygiene and health.”
However, Williams noted that men are tentative about discussing adult circumcision because they are more concerned about the risks of the procedure. “Most men are not willing to get circumcised because they are afraid that it will permanently damage their penis and affect their sexual functioning,” she notes.
She also stated that women do not consider the significance of circumcising their sons in spite of the benefits.
“Our population is not properly educated about human biology and sexuality. It’s not something people are comfortable speaking about. But if we can somehow assure people that the process is safe and can prevent HIV/AIDS from spreading they might be more inclined towards circumcision.”
