Scientists lauded for report on circumcision and HIV

LINDSEY WIEBE, CanWest News Service
Published: Thursday, December 20

Time magazine has named a groundbreaking discovery on HIV/AIDS prevention - spearheaded in part by University of Manitoba researchers - as the top medical breakthrough of the year.

Two studies, one in Kisumu, Kenya, and another in Rakai, Uganda, followed thousands of HIV-negative men over a number of years to determine what effect circumcision would have on the spread of the virus.

The studies were funded by the Canadian Institutes of Health Research and the U.S. National Institutes of Health.

However, the trials were halted last December after early data showed high levels of success, with circumcised men about 50 per cent less likely to get infected. The results were published in the medical journal The Lancet this year.

"It's nice that the issue has got this kind of recognition in the popular press," said Stephen Moses, reached by phone in Bangalore, India.

The University of Manitoba researcher was the co-principal investigator in Kenya, and said the notion that circumcision can protect against HIV transmission has been accepted in the scientific community, and increasingly in the world health community.

The effect of circumcision is related in part to a group of cells found on the foreskin that are more likely to contract HIV, and the fact that the foreskin is more susceptible to tearing during sex.

http://www.canada.com/montrealgazette/news/story.html?id=e0271c1d-5c25-490b-a590-4b9eebaf4004

Male circumcision medical breakthrough

CNN and Time have declared Male Circumcision as the biggest medical breakthrough of 2007. This comes with the recent early closure of two clinical trials on male circumcision conducted in Uganda and Kenya which both showed that male risk of HIV infection through heterosexual sex is reduced by up to 65%. The findings were very similar to a study conducted in South Africa in 2005.

With such overwhelming evidence, the World Health Organisation and UNAIDS have officially recommended the procedure as a way to help reduce transmission of the virus through heterosexual sex.

Several East African countries have put male circumcision at the top of the Public Health agenda. In Uganda, the Ministry of Health has declared that male circumcision services will be free of charge while Rwanda has announced plans to conduct mass male circumcision.

Principle Investigator for the Trial in Kisumu, Kenya, Professor Robert Bailey says, “If male circumcision is taken up by just 50% of men in areas of sub-Saharan Africa where it is currently little practiced, millions of new HIV infections will be averted in men and women. We cannot treat our way out of this tragic epidemic. Until we have an effective HIV vaccine, which is likely to be decades away, circumcision is a major weapon for preventing new infections in areas where most HIV transmissions are through heterosexual activity. The challenge is now to make safe, affordable circumcision services widely available to the many Africans who now are seeking them.”


Top Scientific Journal, the Lancet has called the discovery “A New Era for Prevention.”

http://www.africanews.com/site/list_messages/14084

Rwanda: Start Circumcision With Children - UNAIDS

The New Times (Kigali)

James Buyinza and Paulus Kayiggwa
Kigali

The UNAIDS country programme coordinator, Dr Kékoura Kourouma, has advised Rwandans to start circumcision with children at a tender age as one of the measures to protect them from acquiring with HIV/Aids.

"If the government plans to implement circumcision, it would be easier and cheaper when it targets children. This would enable the programme to achieve its targeted objectives"

Dr Kourouma said this on Friday at a function that marked the UN Family's World Aids Day cerebrations held at World Food Programme headquarters in Kicukiro District.

He further said that the demand for male circumcision as a method of combating HIV/Aids is likely to increase dramatically due to the prevailing results from two studies, in Kenya and Uganda.

However, he warned that circumcision may reduce the risk of HIV infection but does not provide full protection against spread of the virus, adding that this calls for mass sensitization of people to ensure that they have fully understood the benefits of the circumcision campaign before they can take their children for mass circumcision.

Antoine Semukanya, the Deputy Executive Secretary of the National Aids Control Commission (CNLS), said that male circumcision reduces the risk of HIV/Aids infection by 60 percent and should be implemented to scale up the fight against the pandemic.

"HIV/Aids has claimed many lives in Africa and Rwanda in particular; every opportunity aimed at reducing its prevalence should therefore be given priority and circumcision is one of them," Semukanya said.

Semukanya urged parents to talk to their children about the dangers of HIV/Aids saying this would avail them with knowledge of how they can protect themselves from the pandemic.

Prevailing data from a cross-section of research institutions since mid-1980s has shown that circumcised men are less prone to HIV infection than the uncircumcised.

Recently, the government of Rwanda recommended circumcision as one of the measures to curb down the spread of HIV/Aids infection.

http://allafrica.com/stories/200712031074.html

Health Ministry to roll out free circumcision

By Hilary Bainemigisha

THE Ministry of Health is planning to roll out circumcision free-of-charge countrywide as a preventive strategy against HIV/AIDS, Dr Sam Zaramba, Director General, Health Services has said.

“We are currently conducting a needs-assessment and consulting key stakeholders in the area of HIV/AIDS policy and service delivery on how best to do this,” he said.

Male circumcision is associated with 60% reduced risk of HIV infection and the evidence is compelling, Prof David Serwada, the Dean, Makerere University School of Public Health, told stakeholders, who met yesterday at Golf Course Hotel, Kampala. He is the one who led the circumcision trial in Uganda; one of the three that convinced the world that circumcision is effective.

“Male circumcision should now be recognised as an effective prevention intervention for HIV,” Dr Alex Opio, the assistant commissioner national disease control, said. “But we are not promoting circumcision alone since it is not 100% solution. It is going to be an additional strategy, part and parcel of Abstinence, Be faithful and Condom use (ABC).”

Opio said information about circumcision was now public and people were asking the Government for the way forward. “People have the right to access a method that has been proved to work.

As the Government, we are now looking at sensitisation, policy and ethical implications; assessing our preparedness and consulting stakeholders to build a consensus before preparing the policy. To be an effective intervention, male circumcision must be acceptable to people of all faiths, tribes, communities and their leaders.”

The meeting looked at the assessment tool to be used in the coming survey to see how prepared our health facilities, people and facilitation were. This survey will be done in districts like Mbale, Kumi, Kabale, Gulu and Kampala and key stakeholders will be interviewed.

The survey is expected to advise policy makers on how to streamline supply of requirements; train more circumcision personnel, including clinical officers and registered nurses, on how to allocate resources without hurting existing health programmes; decide how best to monitor the procedures and what the best suited circumcision method is.

The meeting also asked for an input from other countries like Kenya and Rwanda where the policies are already made. It advised that where money is not enough, the rollout can be prioritised to begin in areas where circumcision prevalence is low and HIV is high. In areas like Bugisu, where circumcision is done, government will study what to build on and what to discourage. It was also suggested that testing before circumcision should not be mandatory because it may discourage some people and the Government does not have resources to test everyone.

“This procedure is important,” Opio said. “What we don’t want is a situation where we promise free male circumcision and the people flood our services and find us unprepared.”

To work effectively, circumcision should be widespread, be medical, be followed by abstinence for at least six weeks and be used as a complementary strategy to ABC.

http://www.newvision.co.ug/D/8/13/600931

Circumcision A Common Practice During School Holidays

    By Hj Minor Absah

Bandar Seri Begawan - The number of children undergoing circumcision at the RIPAS hospital is increasing, as is the common practice during the school holidays.

According to the person-in-charge, Pg Hj Sahri Pg Sabtu, who has carried out circumcision for over 20 years, about 2,040 children aged between six to 12 years old registered for circumcision this year alone.

The period for circumcision during the school holidays was between November 29 and December 26, 2007. The procedure takes only about 10 to 15 minutes depending on the physical status of the child.

Pg Hj Sahri called for the cooperation from the parents to limit the nurikber of persons accompanying their boy into the operation theatre.

He said such a memo has been circulated to the local media two weeks before the school holidays, informing about the circumcision period.

Asked on the obstacles faced, he said there were instances whereby parents who registered their children have forgotten to bring their children's birth certificates.

"There were also cases where parents have made religious ceremony arrangements in advance when in fact their children's turn for circumcision has yet to be confirmed. We also carried out circumcision during non-holiday season."

One of the children interviewed, a nine-year-old Salmi Samsuddin, said he was informed of the benefits of circumcision, especially from the religious aspects. -- Courtesy of Borneo Bulletin

http://www.brudirect.com/DailyInfo/News/Archive/Dec07/081207/nite10.htm

Mandatory neonatal male circumcision in Sub-Saharan Africa

Mandatory neonatal male circumcision in Sub-Saharan Africa: Medical and ethical analysis.
Peter A Clark, Justin Eisenman, and Stephen Szapor
Med Sci Monit, December 1, 2007; 13(12): RA205-213.

Institute of Catholic Bioethics, St. Joseph?s University, Philadelphia, PA, U.S.A.

The majority of those infected with HIV in sub-Saharan Africa do not have access to antiretroviral therapy, which is known to prolong the lives of HIV-positive persons in industrialized countries. Although the availability of antiretroviral therapy for those infected with HIV has increased worldwide, the infection rate out surpasses those started on such treatment. Without an AIDS vaccine or curative treatment, and given the difficulty in getting persons at risk to adopt healthy sexual behaviors, alternative approaches to decrease the spread of HIV infection are urgently needed. Three recent randomized controlled trials undertaken in Kisumu, Kenya, Raki District, Uganda and Orange Farm, South Africa have confirmed that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 51% to 60%. These three studies provide a solid evidence-base for future health policy. The procedure for adolescents and adults is expensive compared to abstinence, condoms or other methods; and the surgery is not without serious risks if performed by traditional healers using unsterilized blades as often happens in rural Africa. However, neonatally, the procedure is relatively inexpensive and the risks diminish considerably. Mandating neonatal male circumcision is an effective therapy that has minimal risks, is cost efficient and will save human lives. To deny individuals access to this effective therapy is to deny them the dignity and respect all persons deserve. Neonatal male circumcision is medically necessary and ethically imperative.

http://highwire.stanford.edu/cgi/medline/pmid;18049444