Male circumcision for AIDS prevention should be prioritised

JOE WASIA | Supported by the Bob Cleland Writing Fellowship

LIKE MANY DEVELOPING COUNTRIES, Papua New Guinea is greatly susceptible to HIV/AIDS.

Research and studies have done by many countries but there is no cure identified for the deadly disease. Thousands of people are dying every year.

Daily newspapers, radio, television and social media report the deaths of so many people without specifying the disease. But no reports of deaths from AIDS appear in any media in PNG. But AIDS is a major cause of many deaths.

Preventive measures like using of condoms, avoiding exposure to blood, being faithful to one partner, and male circumcision are tools used in many countries.

These preventive measures are recommended by the World Health Organisations and many other global institutions.

In Uganda from 1991-2001, there was a great decrease (from 15% to 6%) in the prevalence of HIV as a result of effective implementation of these preventive measures.

The decrease was multiplied by a multi-sectoral approach with themes such as ‘Love Carefully’, ‘Zero Grazing’, and ‘Be faithful to your Partner’. They managed to make Uganda a paragon of success.

Almost all countries prioritise other measures in preventing, combating and treating HIV/AIDS but very few prioritise male circumcision.

Circumcision is a method of removing the foreskin of a male penis. The soft tissue dries out and becomes normal skin which creates a barrier to prevent the HIV virus and other sexually transmitted illnesses like gonorrhoea and syphilis.

A study conducted by French researcher Bertran Auvert in 2001 revealed, at an international AIDS Society Conference in Brazil, that circumcision in males is far better than AIDS vaccine.

The results of the study showed that circumcised men were 63% less likely than uncircumcised men to be infected through sex with HIV-positive women.

That's a far better rate of protection than the 30% reduction risk set as a target for AIDS vaccine. Similar studies have shown that circumcision in males is a better way of prevention from HIV and other sexually transmitted illnesses.

It therefore seems important for the PNG government and public and private health organisations to introduce male circumcision in hospitals and health centres in our country. I think this could help.

Comments

[Paulus Ripa]

Joe - Current evidence does show that circumcision prevents female to male transmission of HIV. However I suspect that the results are not actually as dramatic as made out and this is due to the way the statistics are presented.

I have looked at 2 out of the 3 randomised trials (the others are observational studies in which the evidence level is weak)and both studies quote their results as relative risk reduction which always looks impressive (50-60% reduction).

However this way of presenting results masks the real figures which are usually expressed as absolute risk reduction which shows a 2% reduction (95% CI of .6 to 3%).

This means 55 men would need to be circumcised to prevent one HIV transmission (this is called NNT or number needed to treat); this is a society with a background HIV prevalence of at least 20%.

It would mean in PNG the real reduction would be much much less (2% prevalence).

On top of that it does not prevent male to female transmission and it does not seem to prevent HPV transmission which causes cervical cancer in women.

The fear that circumcision may lead to decreased condom use may need to be considered. But as a added measure to other strategies circumcision should certainly be considered.

Results of trials need to be interpreted with caution; there is the added factor that trials measure the efficacy of an intervention meaning what happens in the ideal controlled situation but the results in real life are usually less robust.

[Joe Wasia]

So many researches and studies have been done in the world regarding HIV risk reduction by circumcision and it has been confirmed.

No need to argue. If you need to know more go to Google search.

HIV prevalence rate reduction in Uganda is not stated in my article as done by male circumcision. There were other measures that reduce the rate.

Please read closely the article. My call is for the national government of PNG and public and private health institutions in the country to introduce and implement circumcision in the country.

[Hugh Young]

The fall in HIV in Uganda had nothing to do with circumcision - the campaign hadn't started yet - and everything to do with "zero grazing" (one partner at a time).

This is because the virus is at its most transmissible just after it has been received.

The three African circumcision trials (including Auvert's) are very dubious. Less than two years after circumcising a total of 5,400 men, 64 of them had HIV, 73 fewer than similar groups told to wait.

That is the whole basis of the "60% reduction" claim. But 327 circumcised men were "lost from study", their HIV status unknown, so anything is possible.

Another study in Uganda started to find that circumcising men increases the risk to women, but it was cut short before that could be confirmed.

Condoms protect both partners much more than circumcision can, even in theory.

[Joe Wasia]

Hi Charles, you are on the safe side. This is what's needed here in PNG. We can also do it locally like you did.

What government and the health institutions in the country should do is to make circumcision a priority in all hospitals and health centres around PNG. Also educate more locals especially boys how to do it in their villages.

This will reduce the prevalence rate of sexually transmitted illnesses including HIV/AIDS in PNG.

[Joe Wasia]

Hi Charles, you are on the safe side. This is what's needed here in PNG. We can also do it locally like you did.

What government and the health institutions in the country should do is to make circumcision a priority in all hospitals and health centers around PNG. Also educate more locals especially boys how to do it in their villages.

This will reduce the prevalence rate of sexually transmitted illnesses including HIV/AIDS in PNG.

[Kaiam Kaula]

That's true Joe. A lot of studies and research here in PNG and other parts of the world have confirmed that.

I support this call on the national government to integrate with all health institutions in the country to prioritize circumcision. That's the way forward.

[Charles Peter]

That's true, Joe. I believe male circumcision is the way forward in PNG and the rest of the world.

After reading such articles, I went for a circumcision five years ago. Though it is recommended to be done in clinic it was done outside.

I went for circumcision at a village while at secondary school. We got some local experts in almost all villages around PNG who are very good at it.

They remove forehead skin of my penis and roll it at the bottom and it became normal skin hanging on it. And that's better for sexual pleasure as well as disease prevention etc.

When reading down the lines of this article by Joe I feel that I have done something better for my health.

Since this preventive measure is approved and used by many organizations and countries in the world why not PNG.

I support Joe on calling the government, public and private health institutions in the country to prioritize male circumcisions in all parts of the country.