HIV prevention efforts should focus on providing services for male circumcision and reducing multiple sexual partnerships, public health researchers concluded in a report published in the journal Science. The report reassesses the efficacy of several HIV prevention methods including condom use, HIV testing, vaccines, and abstinence promotion.
HIV/AIDS is a global epidemic that has already taken the lives of millions. The Human Immunodeficiency Virus (HIV) takes over the human immune system by predominantly attacking the CD4 lymphocyte. It uses the lymphocyte’s machinery to replicate itself. After an average of ten years, the virus weakens the immune system enough to result in AIDS, or acquired immunodeficiency syndrome. The body’s defenses are damaged and susceptible to infections and tumors.
Transmission of HIV occurs most frequently among high-risk groups such as sex workers and intravenous drug users, according to the UNAIDS 2007 report on the AIDS epidemic.
The report in Science, however, states that in several southern African countries, transmission is not limited to these high-risk groups and nearly 12 percent of adults are infected. This statistic demonstrates an urgent need to reevaluate the impact of current prevention methods. Failure to slow the rate of transmission could mean further devastation of populations across the globe.
Condom use surprisingly does not produce a significant change in slowing the spread of HIV, the report found. Consistent condom use is not practiced by enough of the population to impact transmission levels because it is difficult to maintain, particularly for heterosexual partners.
Similarly, the report concludes that HIV testing does not reflect a population-level reduction in transmission. Testing is important for the initiation of necessary treatment for those who test positive, but studies have indicated that there is no reduction in risk for those who test negative. Testing and treatment for other types of sexually transmitted illnesses have shown minimal impact on population-level HIV transmission as well.
The authors also found that vaccine research so far has not yielded encouraging results; test trials in 2007 demonstrated little effect and were eventually cut short due to possible harmful side effects of the vaccines. Abstinence promotion is not a reasonable prevention method either, because it is not applicable to those aged 20 and above – the group most susceptible to HIV infection.
Male circumcision, in contrast, is extremely effective in heterosexual groups for reducing HIV transmission. In December 2006, the National Institutes of Health released findings from two studies conducted in Kenya and Uganda demonstrating that circumcised men halved their risk of HIV infection. Also, HIV transmission levels are low in areas of West Africa where male circumcision is prevalent.
Another preventative method that has the potential to make a powerful impact on transmission rates is encouraging the reduction of multiple sexual partnerships. In Kenya, promotion of partner reduction and fidelity has been correlated to a decline in HIV, as general trends show men reporting to having fewer sex partners, according to a study published in the South African Journal of Medicine.
Male circumcision coupled with the promotion of reducing multiple sexual partnerships could significantly reduce the transmission rates in portions of Africa that are suffering from the HIV epidemic. Government and health organizations should consequently reconsider the focus of their AIDS prevention campaigns in light of these new findings.
Further reading:
World Health Organization: Male Circumcision in HIV Prevention
The South African Journal of HIV Medicine
It’s not surprising that those involved in the original circumcision research are promoting their interpretation of the results.
A more independent analysis was just published in Future Medicine, and has a different view.
http://www.futuremedicine.com/doi/full/10.2217/17469600.2.3.193
The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the oft-reported 65%, and several of the subjects disappeared. The fact that one study described circumcision as “comparable to a vaccine of high efficacy” seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised. Daniel Halperin is the grandson of a mohel, and seems to think that “maybe in some small way (he’s) destined to help pass along (circumcision)” so his objectivity is questionable.
Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of “dry sex”.
The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circed men than intact men, yet they’ve just started a nationwide circumcision campaign. Other countries where circumcised men are *more* likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. That’s six countries where men are more likely to be HIV+ if they’ve been circumcised. Something is very wrong here. These people aren’t interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives.
Circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men are more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised.
Female circumcision seems to protect against HIV too btw, but we wouldn’t investigate cutting off women’s labia, and then start promoting that.
For a good summary of the case against promoting circumcision in Africa, see this link:
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html