Positive, versus HIV

Mehru Jaffer

Curse upon those community leaders who confuse society! Thanks to them, male circumcision is largely identified today as an act practiced by Muslim men obeying a diktat from the God of Islam.

Therefore, it was news when the Bill Gates called male circumcision as an amazing advance in the prevention of HIV at the 18th International AIDS Conference that concluded in Vienna last month. "I have to admit that when it comes to circumcision, I used to be one of the sceptics. I thought, sure, it reduces transmission by nearly 60 per cent. But there is no way that large number of men will sign up for it. I am glad to say that I was wrong," Gates told more than 20,000 participants.

Although practiced for centuries, it has been only four years since the benefits of circumcision are known. It is unfortunate that just about 1,50,000 men in sub-Saharan Africa have been circumcised, out of the 41 million who need it. There is a call for countries to make this a priority in their policies and funding in order to do a better job of scaling up interventions like circumcision.

Male circumcision is seen as a fine prevention tool. With very little cost, it can drive down the number of new HIV infections dramatically - one way of writing 'the end' for the sorry story of AIDS. Statistics at the conference point out that in a single month 36,000 men in Kenya were circumcised: the government spent $1.4 million. If these men were not circumcised and became infected with HIV at the prevailing rate for uncircumcised males in Kenya, treating them would have cost the government nearly 10 times more money.Of course, circumcision is no magic solution against HIV. However, it is an innovative addition to a more holistic approach to HIV prevention.

Scientists explain that the foreskin of the penis increases the risk of HIV infection in men. Target cells that help HIV enter the body are highly concentrated in the inner foreskin, close to the surface of the skin. Male circumcision reduces the risk of HIV by removing the target cells.

Studies in east and southern Africa indicate a 60 per cent measure of reduced risk of HIV infection among men who are circumcised. African countries with the highest HIV prevalence generally have a situation where male circumcision is not widely practiced.

INDEED, MALE CIRCUMCISION also has its critics. Some human rights groups call it a dangerous mistake. They urge policy makers to halt male circumcision as it is exorbitant, dangerous and unethical. "The promotion of male circumcision sends the wrong message, creates a false sense of protection, and places women at greater risk in terms of HIV. Men are already lining up to be circumcised in the belief that they no longer need to use condoms," points out Georganne Chapin, director of the human rights group, Intact America.

Chapin is concerned that scarce resources are ready to be squandered on this prevention method when new research shows that the use of anti-retrovirals reduce transmission by 92 per cent. Instead, he would like the limited resources available to wipe out HIV to be used for condom programmes and vaccines. Quoting results of other studies on HIV and circumcision, Chapin shows that random clinical trials cannot be applied to the general population of any region. Other studies conclude that circumcision did not have any protective effect on HIV transmission.

Chapin complains of the extraordinarily high rate of complications from male circumcision in Africa. There are reports of 35 per cent complication rate for traditional circumcisions and an 18 per cent complication rate for clinical circumcisions. Africa's over-burdened health care system cannot handle the tens of thousands of complications that might result from the campaigns. In this context, Dan Bollinger, Director, International Coalition for Genital Integrity, quotes a 2008 study that found increased use of condom promotion is 95 times more cost-effective than male circumcision in preventing new HIV infections.

It is considered unethical for circumcision to be carried out on adult males unless fully informed consent is obtained. Apparently, many African males agree to circumcision because they think that they no longer need to use condoms. This reveals that they are consenting to surgery without knowing all the facts. Circumcising infants to prevent HIV is of particular concern and termed a violation of the human rights of male babies. 

All this and much more is a subject of debate. I suppose, all conflicts and all contests are necessary to make way for that ultimate cure for this deadly, slow and fatal plague -HIV and AIDs.

This story is from the print issue of Hardnews: AUGUST 2010