Experts say male circumcision the key to beating AIDS

Aug 5 2008

Experts say while no cure or vaccine for AIDS exists male circumcision could be the key to driving the epidemic into a declining state and closer to extinction.

But though male circumcision can prevent 65 per cent of new HIV infections, many of the countries worse hit by AIDS are slow to promote the procedure.

Experts are now urging countries with high rates of HIV infections which are being transmitted predominantly through heterosexual contact, to include circumcision in a comprehensive HIV prevention strategy because unlike other prevention methods, circumcision is unique, because it is a 'one-time treatment.'

Current strategies to prevent HIV transmission such as abstinence, condoms, early diagnosis and treatment of sexually transmitted infections, and HIV testing, have limitations and at present antiretroviral treatment is not available to millions of HIV- infected people who need it.

However while circumcision protects men who have undergone the surgery, there is no evidence to suggest that the lack of a foreskin in men carrying HIV reduces transmission of the virus to their sexual partners.

There is also resistance in some countries to circumcision over a lack of hygienic and safe settings to perform the procedure, or fears that circumcision would lead to high-risk behaviours as men might feel they have a 'natural condom,' many too men fear that circumcision could reduce their sexual pleasure.

A new study by researchers from the U.S. found among men in Kenya no increased risk- taking behaviours were seen among those newly circumcised.

Epidemiologist and co-author Robert Bailey, from the University of Illinois, Chicago, was among the first to discover that circumcision protects against HIV infection in men who are circumcised because specific cells in the foreskin are favoured targets for HIV, and the inside of the foreskin lacks the tough layer that protects most skin from infection.

At the XVII International AIDS Conference in Mexico City, Bailey presented new research which found that newly circumcised men reported 'increased penile sensitivity and enhanced ease of reaching orgasm.'

The non-profit group Population Services International (PSI), says they are calling on the international community to help national governments introduce male circumcision wherever HIV prevalence is greatest and circumcision rates are lowest in the nations of eastern and southern Africa.

Outside of sub-Saharan Africa, HIV is largely confined to high-risk groups including injecting drug users, sex workers and men who have sex with men and Sub-Saharan Africa is the only area where there the HIV epidemic has spread through the heterosexual population.

As a result, over two thirds of all people infected with HIV live in sub-Saharan Africa.

Low rates of circumcision, which is protective, and high rates of genital herpes, which causes ulcers through which the virus can enter the body, have also contributed to Africa's epidemic.

PSI projects in both Kenya and Zambia and Kenya have been successful with 500 men circumcised in the last nine months and a two-month waiting list.

The PSI says introducing circumcision widely in sub-Saharan Africa could prevent an estimated 2 million infections in the next 10 years and save as many as 4 million lives over the next 20 years.

The strongest evidence of the benefits of male circumcision came from three trials in 2007 in Kenya, Uganda and South Africa which revealed that male circumcision reduced the risk of heterosexually acquired HIV infection in men by 60 per cent.

It is thought that at least 25% of men worldwide are circumcised and in Africa, about 68% are circumcised, often for cultural and religious reasons.

Male circumcision has been around since the Egyptians more than 4,300 years ago.

To date AIDS has killed more than 30 million people in the last 25 years and continues to cause around two million deaths a year, but it can be avoided by taking precautions such as using condoms and avoiding multiple sexual partners.

At the Conference experts have called for a new focus on HIV prevention through behaviour change.