South Africa: Male Circumcision 'Could Cut Soweto HIV 40 Percent'

Business Day (Johannesburg)

Tamar Kahn
Sydney, Australia

HIV prevalence in Soweto could be reduced by close to 40% if half the number of uncircumcised men in the Johannesburg suburb underwent the procedure, an international Aids conference heard yesterday.

SA, with about 5,5-million infected people, has one of the worst HIV/Aids epidemics in the world, but it has yet to develop a policy on male circumcision.

A leading researcher told the conference that international HIV agencies had been slow to promote male circumcision as an anti-Aids strategy because, unlike medicines, no one stood to make money out of it .

"If it were a drug or ... a shot with a fancy label, international agencies and donors would have been fighting to be the first to make it available many months, even years, ago. But no one stands to profit from male circumcision -- no one that is but the 4000 men in Africa who will be newly infected tomorrow, and their partners, and their children," Prof Robert Bailey, an epidemiologist from the University of Illinois, said during his plenary address.

Three recent African studies, including one conducted in SA, have shown that circumcision reduces the risk that a man will contract HIV from an infected female partner by about 60%.

These studies come in the wake of about two dozen small observational studies that noted HIV was less common among men who had been circumcised than among men who had not.

Bailey, who was involved in two recent studies in Uganda and Kenya, urged countries battling large HIV epidemics to stop stalling, and begin offering the procedure to men who had not had their foreskins removed.

"If we had a vaccine that was 60% effective, we would be rolling it out as fast as we could," he said.

In March, the World Health Organisation (WHO) recommended that countries with low male circumcision rates and high HIV prevalence devise policies to provide the procedure, but few countries have taken action.

"Until it is endorsed by local communities and governments it will be difficult for donors (to assist)," said Bailey.

If all men were circumcised, 2-million new HIV infections and 300000 deaths could be averted over the next decade, he said.

Scientists believe the procedure helps protect men from HIV because the foreskin contains langerhans cells that are especially vulnerable to invasion by the virus. There is no evidence so far that circumcision protects women from HIV directly.

Bailey said male circumcision policies should include clear communication programmes to ensure people continued to use condoms, as circumcision offered only partial protection against HIV, which causes Aids.

The conference also saw the launch of a global initiative by the Foundation for Aids Research to combat HIV among men who have sex with men in the developing world. Fewer than 5% of men who had sex with men had access to HIV prevention, treatment and care, the organisation said.

"In many parts of Asia, Africa, eastern Europe and Latin America, stigma, criminalisation, and lack of access to health services have sparked alarming epidemics that threaten to devastate communities of men who have sex with men, mirroring the HIV pandemics that ravaged gay communities in North America and western Europe in the 1980s," the organisation said.

About a third of South African males are circumcised, according to a 2002 study by the Human Sciences Research Council, most as a rite of passage into manhood.