BrightWorld

Dreams, Optimism, Wisdom

CIRCUMCISION AS HIV PREVENTION September 12, 2008

Erle Frayne Argonza

Who says that male circumcision does not have any positive health value at all, that it is more of an esthetic practice than a medical one?

In the Philippines, ‘libreng tuli’ (free circumcision) is among the health services offered by NGOs and social service groups to community members. As President of the KAKAMMPI in 89-93, I led the conduct of this free service for the adolescent boys of Anakbayan in Paco district, (Old) Manila, and in Tondo district, (Old) Manila. Not only were the surgical operations simple and well accepted, they also somehow ensured my group’s relevance among urban poor residents of the beneficiary communities.

But there is the lingering question raised about the true health value of circumcision. With a recent development in HIV research, it seems that the issue is coming to a close finally. Circumcision could very well be very cost effective a way to prevent HIV, and Africa itself could save as much as billions of dollars of prospective medications via male circumcision.

See the exciting news below.

[28 August 2008, Quezon City, MetroManila. Thanks to SciDev database news… The Kakammpi is a national organization of dependents of overseas workers, largely concerned with advocacy and community organizing.  As its president, I was involved in the drafting of a proposed law for migrants that was passed later, as the Omnibus Law for Overseas Workers.]

Circumcision for HIV prevention ‘cost effective’

Mohammed Yahia

11 August 2008 | EN | 中文

Photoshare

[MEXICO CITY] In addition to decreasing the transmission of HIV, circumcision is cost effective and can reduce the risk of human papillomavirus (HPV) infection, researchers have announced.

Researchers presented a mathematical model at the International AIDS Conference in Mexico City last week (6 August) that showed that male circumcision programmes are economically feasible in Sub-Saharan Africa.

While they may cost more than US$900 million dollars to initiate, the budget for antiretroviral therapies would be cut considerably with the reduction in new infections.

“Calculations suggest that, over a 20-year period, two billion dollars would be saved,” said Bertran Auvert, professor of public health at France’s national biomedical institute INSERM.

Auvert also announced that HPV infection can be cut by around 40 per cent in men, as well as circumcision reducing HIV infections by 60 per cent.

“Circumcision could therefore be an indirect way of limiting the risk of genital cancers caused by HPV in women,” said Auvert.

According to Alvaro Bermejo, executive director of the International HIV/AIDS Alliance, studies in South Africa show a high level of acceptance of male circumcision. “We’ve seen high uptake and there are lengthy waiting lists right now,” he said.

But expansion of the practice in Africa has proved slow. “If it were a traditional biomedical product, like a pill, I think we would see roll-out much more quickly,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition. “But you are dealing with a deeply cultural and social issue.”

For example, the elders of the Luo tribe, a large community in Kenya, have refused to endorse male circumcision as it is against their culture and they are not convinced it will decrease the rate of new infections.

And in Indonesia, Christians have been reluctant to get circumcised because the practice is associated with the coming of age for young Muslim boys, explained Karen Houston Smith, deputy director of Family Health International, Indonesia. “They feel this casts some doubt on the validity of their Christianity.”

Bermejo stressed that dialogue and information will be essential for any global strategies to roll out male circumcision.

And the messages need to be clear. “We need to be sure we are not putting women at risk. We need to be sure that men who do get circumcised don’t think that they can now stop using condoms” said Warren.

“But that doesn’t mean we should not be scaling up in a strategic and smart fashion that is addressing all of these other factors.”

 

2 Responses to “CIRCUMCISION AS HIV PREVENTION”

  1. Hugh7 Says:

    “Who says that male circumcision does not have any positive health value at all…”?
    Quite a few scientists who have not been sucked in by the hype of a few enthusiastic circumcisers who have promoted the operation far beyond what the results of some far-from-perfect trials justify.

    Since “men who do get circumcised [must not] think that they can now stop using condoms”, the cost of circumcision is going to be additional to that of condoms, and it is only going to be of any use (if it is of any use at all) where they do not use condoms, so inevitably the circumcision campaign will undermine the condom campaign, and possibly lead to a greater spread of AIDS than before.

    “… that it is more of an esthetic practice than a medical one?”
    Who indeed? It’s only an aesthetic practice to those who are already used to diminished penises. To most of the world, a penis with its foreskin missing is like an ear with its lobe missing or a foot with a toe missing.

  2. Ron Low Says:

    This is so sad. No matter how this message is conveyed, these poor saps are going to have the best part of their penises cut off because they hear “circumcision prevents AIDS.”

    It does not, of course.

    Most of the half-million US men who have died of AIDS were circumcised at birth. In Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Tanzania, it is the circumcised who have the higher incidence of HIV infection.

    At the Mexico City AIDS conference, they declined to hear a presentation explaning how (even if the 3 large Afirca trials were not fraudulent) condoms would be 95 times more cost effective than circumcising to fight HIV.

    Foreskin feels REALLY good. HIS body, HIS decision.


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