Registered nurse midwives could be useful untapped resource for infant circumcision in Africa

A new study indicates that early infant circumcision, which helps to prevent HIV transmission later in life, can be safely performed in rural Uganda.

In 501 infants who were circumcised by either trained clinical officers (256 infants) or registered nurse midwives (245 infants), the rates of moderate/severe adverse events were 2.4 percent with surgeries by clinical officers and 1.6 percent with surgeries by registered nurse midwives. All wounds were healed by four weeks post-circumcision. Maternal satisfaction with the procedure was 99.6 percent for infants circumcised by clinical officers and 100 percent among infants circumcised by registered nurse midwives.

"Preventable HIV infections are still a major concern, and circumcision is one of the priority measures in combination HIV prevention for high burden countries," said Dr. Edward Nelson Kankaka, lead author of the BJU International study. "Our findings suggest registered nurse midwives could be a useful untapped resource for early infant circumcision in Uganda and similar settings, which is more sustainable in the long term."

Source: Wiley

Comments

  1. Mark Lyndon Mark Lyndon United Kingdom says:

    Circumcision is a dangerous distraction in the fight against AIDS.

    From a USAID report:
    "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
    http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
    (this will include men who were circumcised tribally rather than medically, but they and their partners may also believe themselves to be protected, and the whole rationale for the RCTs into female-to-male transmission was a purported correlation between high rates of male circumcision and low rates of HIV)

    It seems highly unrealistic to expect that there will be no risk compensation.  The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".  This figure seems to have been unchanged in 2012.
    http://www.info.gov.za/issues/hiv/survey_2009.htm
    www.hst.org.za/.../...VCommunicationSurvey2012.pdf
    jhhesa.org/sites/default/files/hiv_survey.pdf

    A study in Zambia found that "30% of women at R1, and significantly more (41%) at R2, incorrectly believed MC is fully protective for men against HIV."
    journals.plos.org/.../journal.pone.0149517

    It is unclear if circumcised men are more likely to infect women.  The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:
    www.thelancet.com/.../abstract

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward.  Promoting genital surgery seems likely to cost African lives rather than save them.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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