Male Circumcision

Friday, November 30, 2007

China considers male circumcision in fight against HIV/AIDS

BEIJING (Reuters) - The rate of new HIV/AIDS infections in China is slowing and is now mainly being transmitted through sex, which the government could tackle with a circumcision campaign, the health minister said on Thursday.

The country will have an estimated 50,000 new infections in 2007, compared with 70,000 in 2005, though groups like men who have sex with men are increasingly at risk, according to a report by the State Council, or Cabinet, and the United Nations.

That will mean there will be about 700,000 people living with HIV/AIDS this year in China, up from an earlier estimate of 650,000.

Of the new infections, 44.7 percent will come from heterosexual transmission, 12.2 percent from men having sex with men, and 42 percent from intravenous drug use, the report said.

In the past, most infections were caused by intravenous drug use.

"At present, the AIDS epidemic in China continues to spread, but at a slower rate," Health Minister Chen Zhu told a news conference. "Sexual transmission is now the main route for the spread of AIDS."

Chen said more focus needed to be put on traditionally marginalized groups, like the gay community and drug users, though he added condom use by sex workers had risen from 14.7 percent in 2001 to 41.4 percent last year.

Yet the report found risky behavior by men who have sex with men remained widespread, with just a third using condoms for anal sex.

Chen said that with infections now primarily coming via sexual transmission, a male circumcision campaign could not be ruled out in China.

Studies have shown that circumcision could reduce the risk of HIV infection by up to 60 percent, though it does not offer total protection from the virus.

The World Health Organisation has already recommended it as one of the ways developing countries, especially in Africa, could use to fight the spread of AIDS.

"This is a technical question. I think our experts will evaluate it," Chen later told Reuters. "Even before the AIDS era some children in China were already being circumcised."

Circumcision rates are low in China compared to Asian countries like South Korea or Japan, where the foreskin is often removed at birth for hygiene reasons, or Muslim countries like Indonesia which practice it for religious reasons.

China's Muslim minority, concentrated in the far western region of Xinjiang, likewise circumcise their male children, normally as they reach puberty.

Chen said that were the government to decide to promote circumcision among the wider population, he did not think it would run into much opposition or cultural problems.

"As long as there is evidence it is effective, I don't think it would be an issue," he said.

Reporter Gets Circumcised to Fight AIDS


LUSAKA, Zambia (AP) - A southern African radio correspondent has been receiving a flood of text messages and cell phone calls - some from offended listeners and readers.

All because Kennedy Gondwe chose to get circumcised to protect himself from AIDS, and took the British Broadcasting Corp.'s radio and Web audience through the procedure with him Friday.

A study published in the Lancet medical journal in February concluded that the findings of three major trials - in Kenya, South Africa and Uganda - show that circumcision can significantly reduce men's chances of contracting the virus that causes AIDS. U.N. health agencies followed up with an endorsement, but stressed that the procedure offers only partial protection and that abstinence, condom use, having few partners and delaying the first sexual experience are all among the steps that need to be encouraged.

Frank talk about AIDS and prevention methods, is still rare in Gondwe's Zambia, where HIV prevalence is 16 percent. That's what made the 27-year-old Gondwe's public testimony Friday, the eve of World AIDS Day, even more striking.

A prominent Zambian journalist, Mildred Mpundu, died in November after going public with her HIV-positive status earlier this year and urging her fellow journalists to get tested.

Gondwe, who says he undergoes an AIDS test several times a year, said in an interview Friday he finds it "sad" that more people don't talk about circumcision as a prevention method.

"We as journalists also have a role to play in the fight against the disease," he said.

Gondwe, on the radio piece and in an online diary Friday, recounts his Nov. 22 procedure. Listeners can hear him gasp as a doctor injects him with a local anesthetic, but he assures them the procedure is otherwise painless. He was up, walking to his car and driving himself home soon afterward.

Dr. Jan van den Ende, a microbiologist at Toga Laboratory, which provides AIDS testing and counseling in neighboring South Africa, the country hardest hit by AIDS, said it was not entirely clear why circumcision provides the protection it does. He described it as a relatively simple and painless procedure, something Gondwe's story demonstrated.

While one admiring Web reader from Zambia told Gondwe he would soon follow his example, the reporter said others told him they were offended. Gondwe's Tumbuka people of Zambia's Northern Province do not embrace circumcision, he said.

David Alnwick, a senior AIDS adviser to UNICEF based in Nairobi, said UNICEF supports educating people that "circumcised men are relatively well protected against HIV." But he said there was a danger of creating demand that the world's poorest continent is not now prepared to meet.

Alnwick said Zambia has a long waiting list of men who want to be circumcised and only a few centers providing the service. But he says he expects governments to come aboard across the continent and international donors to provide funding.

Saturday, November 10, 2007

Botswana: Try Circumcision, But Test for HIV - Mogae

Mmegi/The Reporter (Gaborone)
8 November 2007

Thato Chwaane

President Festus Mogae says he is open-minded on HIV prevention strategies in curbing new infections.

Mogae was speaking at a workshop for journalists on Tuesday, aimed at enhancing quality reporting on HIV/AIDS.

He said while some donors advocated for circumcision as a preventative measure, everyone should test for HIV before going through the procedure.

However, he said government was still strategising about circumcision and cautioned that the practice should not mean that anyone is exempt from the virus. He said if there was a correlation between prevention and circumcision then the government is willing to try it.

"There have been many debates on circumcision. Let's try it; we have nothing to lose except foreskins," he said.

"I am open minded. If it takes being of the same religion then let's try it," he said to the amusement of the audience.

He appealed to journalists to join hands in propagating the message of abstinence and advocating for routine testing to be more 'routine.'

Mogae said that he thought that more senior journalists would attend the meeting. "If they think that this is for junior journalists, then they are grossly mistaken," he said.

Mogae said that AIDS is not someone else's problem. "See how many of you have died.

We have to worry about it and have a reason to want to live," he said. He said the press had a role in fighting HIV.

He dismissed an article in a local publication that said the prevalence rate went down in Uganda after people were told to abstain and added that it went down due to the fact that people died.

Mogae said he was once present when over 400 students graduated posthumously at Makerere University. He said he saw people die in Uganda and there was nothing they could do.

Mogae said that there has been awareness and relative success in treatment and care but that Botswana was not out of the woods yet. He said the youth have a chance of an AIDS free generation and that people should know their status.

He said that when the UN used statistics from the sentinel surveillance rate of 37 percent as the prevalence rate in Botswana, they did not argue.

"Any percentage is bad, whether 17.1 percent or the 37 percent of expectant mothers," he said.

He also added that the procurement of ARVs is a national programme and it was not tied to any individual. He was answering one of the journalists who wanted to know what would happen after he left office next year.

Botswana would eventually turn to the use of generic drugs which are cheaper, Mogae warned.

He said that would be done at the end of the current contracts with suppliers. The imminent change would reduce costs, he anticipated.

Mogae allayed fears that in the 'worst case scenario' when donors would pull out, the programmes would still continue as 86 percent of the country's expenditure on ARV's originates in Botswana.

He said he would continue being engaged in issues relating to AIDS, with organisations and friends abroad, even as a former president.

The two-day workshop was titled "The role and challenges of leadership in the response to HIV/AIDS".

AIDS & CIRCUMCISION: Snip, Snip, Oh What a Relief It Is

Phill Wilson 

This summer, the Bush administration revealed that it will use part of its $15 billion a year global AIDS program 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 endeavor. Everybody involved will have to abandon old bad habits if we are to have a sober dialogue about reducing risk for HIV. Public health must respect communities' traditions and individuals' choices; communities and individuals must discard reflexive distrust of public health.

The facts today are hard to dismiss. 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?

Laboratory studies have established that the foreskin's inner lining has a high density of the cells that HIV targets. Researchers also believe foreskin is more likely to tear during intercourse, allowing openings for the virus. 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. In doing so, however, the scientific community must respect the justified concerns both communities and individuals may present-too many years of abuse at the hands of pseudoscience have left communities of color around the world distrustful of health officials. Any outsider-driven, top-down campaign urging men to have skin removed from their penises will no doubt deepen that skepticism. I'm sure every man reading this column is crossing his legs right now.

So as public health officials gear up their response to the compelling data on circumcision, it is important that our leaders do the leading, including investing in raising the HIV science literacy among local leaders and supporting culturally appropriate venues where local communities can develop the tools needed to interpret the science.

At the same time, people of color around the world no longer have the luxury of allowing other folks' mistakes to hold us captive. If we're going to survive this epidemic, we must begin taking responsibility for our own lives. That means, no matter what the scientific community does, and no matter what any local health department does here in the U.S., we must learn the facts about circumcision and HIV.

Male circumcision the key to controlling the spread of AIDS in Africa

In what is being coined as a ‘landmark’ trial, researchers have found evidence that male circumcision (MC) could reduce the chance of becoming infected with HIV.

World Health Organization researchers have estimated that being circumcised reduces the chance of men becoming infected with HIV infection by as much as 60%.

The human immunodeficiency virus or HIV, which causes AIDS, now infects close to 40 million people and has killed another 25 million.

It is most prevalent in sub-Saharan Africa and the main method of transmission is sex between a man and a woman.

Dr. Bertran Auvert of the French National Research Agency INSERM and colleagues analyzed data from trials that showed men who had been circumcised had a significantly lower risk of infection with the AIDS virus.

MC has been practised by many of Africa’s ethnic groups for many centuries and it commonly takes place in late childhood or early adolescence.

Circumcision is believed to help reduce the risk of infection because the foreskin is covered in cells which the virus is able to easily infect.

The virus may also survive better in a warm, wet environment like that found beneath a foreskin.

In West Africa, male circumcision is common and the prevalence of HIV is low, while in southern Africa the situation is the opposite.

If men were circumcised, fewer would become infected and therefore could not infect their female partners.

When the researchers took into account information on HIV infection rates and the prevalence of male circumcision across Africa, they worked out that if all men were circumcised over the next 10 years, some two million new infections and around 300,000 deaths could be avoided.

They say when a variety of possible outcomes that might arise if MC is widely promoted and making calculations for 10, 20 and 30 years time, the number of lives saved would be somewhere in the range 1.6 - 5.8 million.

They project that universal male circumcision would reduce the rate of infections by about 37 percent.

The research is published in the journal the Public Library of Science Medicine.