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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