Sunday, July 15, 2007

Stephen Lewis on HIV and circumcision

Former U.N. Special Envoy for HIV/AIDS in Africa and Canadian Ambassador to U.N., Stephen Lewis recently had this to say on NPR's Worldview

"If I may draw a parallel, suddenly everybody is clamoring for circumcision for men, because that seems, a circumcised male, that seems to cut down the transmission from a woman to a man by something like 60% or better, so it's very beneficial to the men to be circumcised, and we've known for years that male circumcision was an important preventative intervention, and everybody speculated and spent endless time ruminating on whether or not it should be done, and then there were three studies in Uganda, Kenya, and South Africa showing unequivocally and categorically that it cut transmission to men by more than 60% in some cases, and I notice in the last 24 hours UNAIDS has now called for mass circumcision starting with young children. You know, 7 or 8 years ago there were people calling for that, and for whatever reason it has taken all this time to get around to it."

“…there is too much inertia, there is a lack of urgency and emergency about fighting for individual lives, it’s as though Africa were somehow expendable. “If this were going on in Europe we would be have this kind of carnage and its not because the European health system are so infinitely superior, which they are, its because we would never allow it to happen to the people of Europe as we are allowing it to happen to the people of Africa. I do sense a greater intensity about the response, I don’t want to pretend otherwise, I do sense that the world is beginning to understand that this has been an apocalypse for the continent and will be measuring it for years and decades to come and maybe we turned a corner in that sense but it is taking an unconscionably long time and when you mention as well the question of gender inequality, well gender inequality is driving this pandemic and the dreadful position of women and the absence of sexual autonomy is undoubtedly what lies at the heart of much of the pandemic.”

"I remember, I have a very close collegue as a matter of fact, she's the co-director of AIDS-Free World who was working with UNICEF in East Africa back at the turn of the century, and she suggested, I thought with enormous inspiration, that all infants should be circumcised when we were doing immunization. I mean, it's perfect. You're doing measles immunization, you're doing polio immunization, you're doing it with infants, it would be a perfect way to combine circumcision, providing you were able to set up the procedure in safe circumstances. That's what UNAIDS is calling for today, exactly that, and at the time she suggested it 7 years ago, all the men in the office, you know, clutched their crotches and recoiled with horror.."

End of Quoted text.

It should be noted that the desperate attempts by the anti-circumcision activisits, who pretend to have human rights concerns, to counter the connection between the lack of circumcision and a higher risk of HIV infection to the extent they are clearly willing to allow millions of people to die from AIDS rather than accept that their position of the foreskin has been wrong and that as opossed to being "vital'" as they have claimed the foreskin has become a public health risk. One has to consider the mental health of anti-male circumcision activists when they show so little concern for the millions of deaths that would be averted if circumcision is actively used as one of the preventative measures against HIV infection.

See study below for the impact a roll out of male circumcision will have upon HIV infection rates:

BMC Infect Dis. 2007 Mar 13;7:16.

Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa.

Nagelkerke NJ, Moses S, de Vlas SJ, Bailey RC.

BACKGROUND: Recent clinical trials in Africa, in combination with several observational epidemiological studies, have provided evidence that male circumcision can reduce HIV female-to-male transmission risk by 60% or more. However, the public health impact of large-scale male circumcision programs for HIV prevention is unclear.

METHODS: Two mathematical models were examined to explore this issue: a random mixing model and a compartmental model that distinguishes risk groups associated with sex work. In the compartmental model, two scenarios were developed, one calculating HIV transmission and prevalence in a context similar to the country of Botswana, and one similar to Nyanza Province, in western Kenya.

RESULTS: In both models, male circumcision programs resulted in large and sustained declines in HIV prevalence over time among both men and women. Men benefited somewhat more than women, but prevalence among women was also reduced substantially. With 80% male circumcision uptake, the reductions in prevalence ranged from 45% to 67% in the two "countries", and with 50% uptake, from 25% to 41%. It would take over a decade for the intervention to reach its full effect.

CONCLUSION: Large-scale uptake of male circumcision services in African countries with high HIV prevalence, and where male circumcision is not now routinely practised, could lead to substantial reductions in HIV transmission and prevalence over time among both men and women.