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How effective is male circumcision against HIV?

By Vision Reporter

Added 12th February 2007 03:00 AM

UGANDA has experienced a new biomedical AIDS prevention strategy — male circumcision. Male circumcision, the surgical removal of the foreskin of the penis, could help reduce the risk of acquiring HIV.

UGANDA has experienced a new biomedical AIDS prevention strategy — male circumcision. Male circumcision, the surgical removal of the foreskin of the penis, could help reduce the risk of acquiring HIV.

By Kellen Namusisi

UGANDA has experienced a new biomedical AIDS prevention strategy — male circumcision. Male circumcision, the surgical removal of the foreskin of the penis, could help reduce the risk of acquiring HIV.

Two studies are being conducted by the Rakai Health Sciences Project in southern Uganda, on male circumcision as a strategy to reduce HIV infection in men who are circumcised and free from the virus. Results have shown that circumcision can reduce the risk of HIV infection substantially in circumcised men, compared to their un-circumcised counterparts.

Removal of the foreskin causes more rapid drying of the penis after sex, bathing or urination. This may reduce the likelihood of bacterial or sexual infections which flourish in dump environments. The presence of a bacterial sexual infection can increase the risk of HIV infection by providing a transmission avenue through lesions. So a strategy like circumcision, which reduces these infections, might also reduce the risk of acquiring HIV.

However, it is very important to note that male circumcision does not offer 100 percent protection. It is only a strategy that can reduce the risk of transmission of HIV and therefore it is not to be taken as a substitute for other preventive methods such as use of condoms.

If male circumcision proves effective, it could have a positive impact on the AIDS epidemic. One model estimates that if this procedure reduces the risk of HIV infection by 60%, as found in the South African trial, three million new HIV infections could be averted over 20 years.

For male circumcision to be affective in Uganda, certain issues must be factored in. For instance, effects of female genital mutilation and whether male circumcision protects the female partner of an HIV-positive man.

Male circumcision in Uganda is a cultural and religious tradition which is performed by medical professionals and non-medical people. The culture of male circumcision is mainly practised in eastern Uganda among the Bagisu and among the Bakonzo in western Uganda. It is done to initiate young men into adulthood. In addition, the ceremony is a way of showing that the young man is brave enough to stand the ‘knife’.

In the case of religion, circumcision is mainly practiced by Muslims who usually perform it immediately a male child is born. It is taken as a symbol or identity for a true Muslim. Therefore, suitability of the strategy should consider cultural and religious practices and beliefs towards circumcision when it is introduced in the context of HIV prevention.

There are cultures that have been practicing female circumcision as a way of initiating young girls into adulthood. However, the practice has been proved by health professionals to be dangerous to the health of the young girls.

Reproductive health programmes have been put in place to try and change the practice. Hence promoting male circumcision should take into consideration female circumcision.

The other challenge or question is whether male circumcision reduces HIV transmission to females whose partners are HIV-positive? Therefore promoting male circumcision will require consideration of circumcision as culture, protection for the female partners and female circumcision as factors that can affect acceptability.

The writer is IPH-CDC Fellow

How effective is male circumcision against HIV?

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