Global Health Ideas

Finding global health solutions through innovation and technology

Male circumcision reduces risk of HIV

Yesterday the National Institutes of Health announced the halt of two randomized control trials on male circumcision for HIV prevention. To continue the studies, the investigators believed, would be unethical. From the NIH news release posted on Politics and Policy of HIV/AIDS*:

The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.

More from the NIH press release

“Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition,” notes NIAID Director Anthony S. Fauci, M.D. “We now have confirmation—from large, carefully controlled, randomized clinical trials—showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse. While the initial benefit will be fewer HIV infections in men, ultimately adult male circumcision could lead to fewer infections in women…

Scaling the intervention will be interesting, to say the least. The procedure can be conducted safely on infants, boys and young men in a clean field clinic setting. Risk of minor adverse events is low, though present. It is low cost; one South Africa study estimated the average cost to be $55 per patient and considering that it’s a one-time procedure with an estimated 50-60% reduced rate of infection, it’s likely to be highly cost effective in populations with a high prevalence of HIV.

However, in my own limited time in East Africa, questions about circumcision for HIV prevention raises mixed responses among colleagues. It’s a topic weighted with ethnic and religious identities. Yet, Culture should not be overplayed especially in light of the incredible potential implied by the recent findings. The early response in southern Africa to a similar study finished in Orange Farm last year (see “Swaziland to endorse male circumcision“) suggests that the intervention, given its solid science and policymakers’ strong endorsement, can quickly gain public interest and save lives. A detailed mathmatical model published last July (“Potential impact of male circumcision on HIV in sub-Saharan Africa“) estimates that 1.1 to 3.8 million lives can be saved in the next ten years if male circumcision is scaled quickly across sub-Saharan Africa.

*full disclosure: I help run the Politics and Policy of HIV/AIDS blog and the link and NIH news quote are from a post I made Dec 13th when the MC news was first released.

Technorati Tags: , , ,

Advertisements

Written by Ben

December 14, 2006 at 2:26 pm

2 Responses

Subscribe to comments with RSS.

  1. It’d be great to read the findings. The 2005 South African randomized control trial on male circumcision had strikingly positive results. I linked to their study above and here [Auvert, et al. 2005. PLoS. “Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial”] There has been observational evidence accumulating since the 1990s that male circumcision is protective [see Halperin and Bailey, 1999, Lancet. “Male circumcision and HIV infection: 10 years and counting”] but these RCTs from last year and this past month are seen as conclusive evidence. There are interesting questions about the magnitude of the protective effect for pediatric versus late teen circumcision and additional reports on populations where the effect may not be observed will help in properly targeting the service as national circumcision programs are ramped up in the near future.

    bellows

    December 21, 2006 at 9:40 am

  2. Interestingly, in South Africa, you do not see the benefit from male circumcision on HIV transmission. This may be due to several factors, including the fact that many boys are sexually active before circumcision, which is part of the cultural initiation into manhood. Dr. Leickness Simbayi of the HSRC, who is a lead investigator on the South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey, is writing up these findings for publication. Will post when the article is available.

    Farzaneh

    December 21, 2006 at 4:12 am


Comments are closed.

%d bloggers like this: