Sunday, August 26, 2007

Uganda: Circumcision And Facts About HIV

The Monitor (Kampala)

23 August 2007

Phill Wilson,
Executive Director,
Black Aids Institute.

President George Bush's administration revealed on Sunday that it will use part of its $15 billion-a-year global Aids programme to promote male circumcision in sub-Saharan Africa as an HIV prevention tool. The news is a welcome development that, for once, puts science at the forefront of the administration's response to this epidemic.

However, both abroad and here at home, educating people about circumcision as a way to slow HIV's spread is a necessarily sensitive endeavour. Everybody involved will have to abandon old bad habits if we are to have a sober dialogue about reducing HIV risk. Public health must respect communities' traditions and individuals' choices; communities and individuals must discard reflexive distrust of public health.

Study after study has found that HIV transmits far less easily through the skin of a circumcised penis than it does when the foreskin is still intact. Circumcision is a procedure in which the foreskin covering the tip of the penis is removed.

The most widely reported studies establishing the prevention benefits of circumcision come from Kenya, South Africa and Uganda, completed in 2005 and 2006. Researchers tracking groups of circumcised and uncircumcised men in those countries found the rate of HIV infection among men who had their foreskins removed to be anywhere from 51 percent to 76 percent lower. Those are big numbers, and they're just the latest studies to come up with such striking results.

Why does circumcision make such a difference? There are many theories. Laboratory studies have however established that the foreskin's inner lining has a high density of the cells that HIV targets.

Researchers also believe circumcised skin is both less porous and less likely to tear during intercourse, and thus provides fewer openings through which HIV, or other pathogens, can pass. More studies should pursue the question.

Meanwhile, public health must begin to make people aware of the dramatic difference circumcision appears to make in HIV risk. So as the Bush administration gears up its response to the compelling data on circumcision, it will be well advised to help local leaders do the leading, which is something its Aids programme has proven reluctant to do in the past.

That includes investing in raising the HIV-science literacy among local leaders and supporting culturally appropriate venues where communities can develop the tools needed to interpret the science.

No matter what the Bush administration does, and no matter what any local health department does here in the U.S., we must learn the facts about circumcision and HIV.

It is an entirely appropriate choice for any individual to opt against circumcision as a method of HIV prevention. But he must make that choice based on the facts, not as a self-defeating reaction to fears about government abuse.