Male Circumcision the Most Important Tool to Limit the Spread of HIV

by Gopalan on  May 13, 2008 at 12:16 PM AIDS/HIV News
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 Male Circumcision the Most Important Tool to Limit the Spread of HIV
A quarter of a century since the discovery of the HIV virus, male circumcision remains easily the most important tool to contain the spread of the dreaded AIDS. Especially so in the worst-affected regions like Africa. For billions of dollars spent on AIDS vaccine research have gone down the drain.

Meantime the heterosexual Aids epidemic has spilled into the general population in sub-Saharan Africa, rather than being confined to high-risk groups, such as sex workers and their clients.

Daniel Halperin, of the Harvard School of Public Health, one of the co-authors of a study on the issue, said, "We need to do a better job in reducing the rate of new HIV infections," said Dr Halperin. Less than 1 per cent of the funds spent by the UN programme has gone on male circumcision yet the other, more expensive strategies have failed to live up to expectations.

"We need a fairly dramatic shift in priorities, not just a minor tweaking," Dr Halperin told Steve Connor, Science Editor of the UK-based newspaper Independent.

Cutting off the foreskin has been shown in several studies to curb the spread of HIV through heterosexual contact by reducing the risk of infection. In men, the risk falls by 60 per cent, but even in women there is a knock-on effect with fewer infected men in the general population.

"Over time, male circumcision, which has been called a 'surgical vaccine', would probably protect more women, albeit indirectly, than nearly any other achievable HIV prevention strategy," the scientists say in their study, published in the journal Science.

More than 45 studies over the past 20 years, including three large clinical trials in Africa, have shown the benefits of the operation in reducing the risk of infection among heterosexual couples. "Unlike most other interventions, male circumcision is a one-time procedure that confers lifelong protection. Modelling suggests that male circumcision could avert up to 5.7 million new HIV infections and three million deaths over the next 20 years in sub-Saharan Africa, many of these among women," said the scientists.

The use of condoms among heterosexual couples in Africa is not as high as in other countries such as Thailand, where the heterosexual HIV epidemic was largely confined to sex workers.

In western Africa, were male circumcision is high for cultural and religious reasons, the prevalence of HIV is low and controlled trials have shown that the operation can stem the rate of infection, said Professor Malcolm Potts, of the University of California, Berkeley. "It is tragic that we did not act on male circumcision in 2000, when the evidence was already very compelling," he said. "Large numbers of people will die as a result of this error."

Source: Medindia

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The primary advice just doesn't change. A recent article[4], The No-Brainer Syndrome, discusses this point particularly well; as does a recent, and far more rational, editorial in Future Medicine[5]. The Australian Federation of AIDS Organization's had two excellent publications on this issue: Their July 2007 statement[6] and one that was distributed at at last year's International AIDS Society Conference[7]. The second said in part: "How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection)." That's good advice.

There has been a lot of progress made in Africa over the last decade with regard to HIV. In Rwanda, for example, the HIV/AIDS rate has fallen from 11% of the adult population in 2000 to 3% in 2007 using conventional HIV reduction strategies. There are no short cuts, no silver bullets. The only way to deal with HIV in Africa is through safe sex, education, and pulling people out of poverty. We won't cut our way out of it and if we want to do them a favor we would buckle down and do the actual hard work that needs to be done. If condoms are not available everywhere we need to solve the distribution problem. If they are for some reason not willing to use them this too must be fixed. It is a message that we shouldn't muddy lest we undo all the hardwork that has been done to ameliorate the epidemic over the last 20 years.



[3] De Vincenzi, I. “A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners,” New England Journal of Medicine 331 (1994): 341-6.


What these authors are suggesting here is insane. There is a very real risk that many people will miss the part that CONDOMS are STILL required. There are already stories leaking out about people overestimating the protective effects.

It is already happening, in this recent article in the trinidad express[1], we have this gem: "Aah," one subject said during trials, "I have a natural condom." Or from Rwanda, in a recent article[2] by David Gusongoirye, Nothing can fight HIV/AIDS better than discipline, speaking of the new campaign a man was quoted as saying: "Mister, these Aids people have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one. Don’t have sex, don’t do this, don’t do that. Eh, man, how can a young man such as I forfeit sex, eh? And the condoms – where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!" There are some circumcised man who will get HIV in part because now they believes they have a "natural condom".

In a study published on the effectiveness of condoms in preventing HIV acquisition, heterosexual couples that included an HIV-infected partner used condoms consistently in a total of about 15,000 instances of intercourse. None of the uninfected partners became infected.[3] So if we just get down to the proverbial brass tacks the whole issue boils down to the following question: If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected? Clearly the answer is no. The critical point is you have only two options:

A. You don't need a circumcision, but you need to always wear a condom and be choosy about your sex partners.

B. You can get a circumcision but you need to always wear a condom and be choosy about your sex partners.


Nowadays, people become active to sex to show their loves to their partners. In related to this we should be aware how to protect our health from different diseases that could get by sex. STD a venereal disease is one of this; it’s an illness that transmits by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex. If you are active in sex you should be aware how STD can affect you. STD can only avoid if you abstain from sex complete. However, if not, you and your partner can still be free to STD by having an STD Test which is preferred than using condoms.

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