Male Circumcision

Wednesday, February 27, 2008

Rwanda continues with male circumcision roll out.

Rwanda To Launch Campaign Aimed at Addressing Circumcision Myths, Encouraging Procedure in Effort To Prevent HIV

[Feb 26, 2008]

Health authorities in Rwanda are planning to launch a nationwide campaign this year aimed at addressing myths about male circumcision and encouraging men to be circumcised in an effort to prevent the spread of HIV, McClatchy/Miami Herald reports (Bengali, McClatchy/Miami Herald, 2/24).

Rwanda announced plans to launch the campaign in September 2007. According to final data from two NIH-funded studies -- conducted in Uganda and Kenya and published last year in the journal Lancet -- routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65%. The results of the Uganda and Kenya studies mirrored similar results of a study conducted in South Africa in 2005. In response to the findings, the World Health Organization and UNAIDS in March 2007 recommended the procedure as a way to help reduce transmission of the virus through heterosexual sex (Kaiser Daily HIV/AIDS Report, 1/24).

The campaign will initially target the army, police officers and university students, Innocent Nyaruhirira, the country's health minister, said. The campaign will aim to reduce the cost of the procedure, which can be as much as $55 at private hospitals, as well as ensure it is covered by basic health insurance policies.

According to McClatchy/Herald, many men in the country have already received the procedure. Justin Gatete -- a nurse at a clinic in Kigali, Rwanda's capital -- said he performed more than 1,000 circumcisions last year.

"We're not going to wake up one morning and have all men be circumcised," Anita Asiimwe, director of Rwanda's Treatment and Research AIDS Center, said, adding, "We need to see how best to implement this."

Health experts from the U.S. are helping Rwandan officials develop the campaign. The Bush administration has said it would allocate funds in the President's Emergency Plan for AIDS Relief to make circumcision more accessible in Africa. Kenya, Swaziland and Zambia have announced plans to make the procedure available in public clinics.

Saturday, February 23, 2008

Circumcision and Human Papillomavirus Infection in Men

J Infect Dis. 2008 Feb 19

Hernandez BY, Wilkens LR, Zhu X, McDuffie K, Thompson P, Shvetsov YB,
Ning L, Goodman MT.
1Cancer Research Center of Hawaii and 2University Health Services,
University of Hawaii, Honolulu.

Lack of circumcision has been identified as a risk factor for male genital human papillomavirus (HPV) infection, although this association has not been consistently supported.

Specimens for HPV testing were collected from a cohort of 379 (primarily heterosexual) adult males. HPV prevalence in the glans pe nis and coronal sulcus, penile shaft, scr otum, semen, and urine was compared by circumcision status.

Overall, HPV DNA prevalence ranged from 6% in semen to 52% in the penile shaft. The prevalence of any HPV infection in the glans/corona was significantly higher in uncircumcised men (46%) than in circumcised men (29%) (odds ratio [OR], 1.96 [95% confidence interval {CI}, 1.02-3.75], adjusted for demographic characteristics and sexual history). Uncircumcised men also had an increased risk of oncogenic HPV infection (adjusted OR, 2.51 [95% CI, 1.11-5.69]) and infection with multiple HPV types (adjusted OR, 3.56 [95% CI, 1.50-8.50]). Among uncircumcised men, HPV prevalence in the foreskin (44%) was comparable to that in the glans/corona, and type-specific positivity was observed between the 2 sites.

Uncircumcised men have an increased risk of HPV infection,including with oncogenic HPV, specifically localized to the glans/corona, possibly because of its proximity to the foreskin, which may be particularly vulnerable to infection.

Sunday, February 10, 2008

Circumcision: SA men ‘not snipped properly’

Published:Feb 10, 2008

UP TO half of circumcised South African men did not undergo the procedure “properly”, leaving them more at risk of contracting HIV than men who went under the scalpel in a clinical setting.

This was one of several findings presented to an international conference in the US this week, attended by the world’s top HIV/Aids researchers.

Recent research worldwide has shown that male circumcision may decrease the chance of contracting HIV, which targets cells in the foreskin.

The World Health Organisation last year recommended circumcision as an effective intervention in the fight against Aids.

French researcher Dr Bertran Auvert of Versailles University suggested this week that 40% to 50% of circumcisions in Southern Africa were only “ritual” or “partial” circumcisions — where the foreskin was not completely removed.

HIV trials conducted in South Africa, Kenya and Uganda showed that only clinical circumcision could reduce the risk of males getting HIV, said Auvert.

“What I know is that not all who say that they call themselves ‘circumcised’ are clinically circumcised,” he said. “In fact their penises are completely intact.”

Of the estimated 165 million men in Sub-Saharan Africa, about 54 million (33%) were uncircumcised, Auvert said.

He detailed a plan for a massive circumcision roll-out in sub-Saharan Africa.

Wednesday, February 6, 2008

Now we know: Circumcision saves lives

Now we know: Circumcision saves lives

Larry Krotz, National Post
Published: Tuesday, February 05, 2008

We can all be rightly proud as Canadians that Canadian scientists, a Canadian university, and, yes, that entity in perpetual short supply, Canadian research dollars, played a substantial role in what has been designated by TIME magazine as one of the biggest medical breakthroughs in 2007. Number two on their recently published top-10 list is the discovery that circumcised men are "at least 51% less likely than uncircumcised men to acquire HIV during sex with women."

In Africa, where the clinical trials that reached this conclusion were carried out, this is very big news indeed because heterosexual sex is the main form of transmission of the deadly virus. Due to tribal customs, many African men remain uncircumcised. If they can get access to circumcision surgery, it is likely to have a dramatic effect on HIV rates.

In the late 1980's, Dr. Stephen Moses of the University of Manitoba, already involved in AIDS research in east Africa, had a hunch there might be a correlation between male circumcision and HIV infection rates. He and another Manitoban, Dr. Francis Plummer, had seen how a variety of sexually transmitted diseases created portals for HIV entry and how circumcised men had fewer STDs. But it took until 2002 for Moses to muster the right partners, the ideal study group, and enough interest from funders to support a properly controlled clinical trial.

With Dr. Bob Bailey of the University of Illinois in Chicago and a local partnership with the University of Nairobi, they opened a clinic in the west Kenya town of Kisumu in order to test the hypothesis. The Canadian Institutes of Health Research (CIHR) paid to build the clinic and, with the U.S. National Institutes of Health (NIH), promised support for five years while the scientists set out to find 2,800 young men from the Luo tribe who might volunteer to be research subjects.

Theirs was one of three such studies. Another by French scientists had been set up in Orange Province, South Africa, and a third took place in Uganda. Early on, Moses and Bailey told me how the work of all three was perceived as long-shot, peripheral research while the major efforts in the AIDS war were going into the search for a vaccine and new antiretrovirals.

The researchers experienced their share of difficulties, most of them having to do with the tricky business of carrying out complicated scientific research in a distant corner of Africa.

They had to overcome local prejudices against circumcision and labour hard simply to keep track of their 2,800 research subjects for two years. Their clinic staff were continually dealing with small crises of behaviour -- one young man had sex two times within eight days of his surgery, something he had been adamantly counselled against, while another rode his bicycle home after the surgery, which did him no good.

The early numbers were so good that some argued it was potentially unethical to require control groups to remain uncircumcised even for the duration of the studies. In 2005, the South African study was halted. Eighteen months later, in December 2006, and a year shy of completion, the Kenyan and Ugandan projects were also halted. The scientific method had been trumped by ethics.

As it was, the Manitobans and the University of Illinois already had proved their point by publishing their findings in the prestigious scientific journal Lancet. Instantaneously, Moses and Bailey moved from the fringes of the formerly sceptical AIDS-research world to the very centre. Bill Clinton singled out circumcision in his speech to the World AIDS conference, Bill Gates turned on the money tap, and finally came anointment by TIME magazine. Henceforth, circumcision as a preventative strategy will be a player along with vaccine research, condom use and antiretrovirals. "In areas where HIV-1 prevalence constitute a generalized population epidemic," stated an editorial in the Lancet, "male circumcision could have a dramatic life-saving effect."

CIHR, the government of Canada's health-research funding agency, is properly claiming bragging rights -- achieved at a bargain-level investment of $2.7 million. This is but a taste of the sort of success we could achieve with a greater commitment: Though it spends more than twice as much as it did in 1999, CIHR's current budget of $700-million is still outstripped 40 times over by the equivalent U.S. body, the National Institutes of Health, which has a budget of US$28-billion.

Dr. Moses and Dr. Plummer have done Canada proud, and are showing how much good we can do when we set our minds -- and money -- to the task.