The Other Face of Circumcision in HIV War

By Michael Bahinyoza

The Geneva-based World Health Organisation has reportedly, over the last couple of months been leading UN Agencies (UNAIDS, UNICEF, UNFPA) to support particularly African countries to develop male circumcision policies and strategies in the broader/ comprehensive HIV prevention strategy.

This follows results from the three Randomised Controlled Trials (RCTs) undertaken in Kisumu (Kenya), Rakai (Uganda) and Orange Farm (South Africa) showing that male circumcision could reduce the risk of heterosexually acquired HIV infection in men by about 60 per cent.

According to media reports, Rwanda has already rolled out male circumcision in the military, a country where ironically, circumcised men have a higher rate of HIV than 'intact' men. (www.circumcisionandHIV.com).

A colleague told me last week, seven of his friends (all of them single) had been circumcised in this ended month of July and that the RCT findings had majorly influenced their decision. It is worth noting that because of information deficiency and other challenges, there have been a number of exaggerated claims made for the reported efficacy of male circumcision in preventing HIV infection.

Many people are not even aware that the results from the above mentioned Randomised Controlled Trials are about prevention of female-to-male HIV infection.

Secondly, not many young people (and probably adults as well) seem aware that the trial results clearly indicate that male circumcision reduces the risk of infection. Unfortunately, many young male adolescents and some men prefer reading or hearing reducing the risk as eliminating the risk.

Undoubtedly, there is 'a heaven of difference' between risk reduction and risk elimination and hopefully, this can be well grasped in the preventive campaign against HIV/Aids.

Reputable senior research fellows, Garry Dowsett and Murray Coach, from Australia suggest in their findings; "The use of male circumcision in preventing HIV infection" that the results of the three RCTs contain exaggerated claims. In his work; "The Demonisation of the Foreskin and the Rise of Circumcision in Britain," Darby RJL, too, brings to the fore what he considers information that the respective supervisors of the three RCTs should not have ignored.

Apparently it turns out that all the three RCTs were terminated early, arguably before the incidence of HIV infection in the circumcised males caught up with the incidence of infection in the non-circumcised males.

It is therefore highly probable that non-circumcised males got infected more quickly than their circumcised friends because the circumcised males required a period of abstinence after circumcision, suggesting, among other things, likely that if the studies had continued as initially scheduled, the difference in infection incidence between the two groups of males would have been small.

As has been noted by our own Ministry of Health, male circumcision does not protect women. Since viral load is the cardinal predictor of the risk of HIV transmission, male circumcision would not reduce the viral load and thus infectivity to the female partner.

For now, it may be wise for our own Ministry of Health, the medical fraternity and the public to be cautious and not to be overwhelmed by the 'hyperbolic' promotion of male circumcision in HIV prevention.

Pre-marital chastity and fidelity, nurtured and supported by needed life skills within viable and dynamic support groups, remain time-tested HIV/AIDS preventive weaponry as the infected and affected are given needed care and support.

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