Aids expert sceptical about benefits of male circumcision

News  South China Morning Post (Hong Kong). Friday, 12 October 2007.

Lina Lim

Recent studies have shown no evidence that male circumcision lessened the spread of HIV, a leading expert on the disease says.

Director of the UNAIDS Regional Support Team for Asia and the Pacific, J.V.R. Prasada Rao expressed scepticism about the popular belief, which if confirmed, could help prevent the disease in men.

Circumcision has been shown to work — there is evidence that sometimes it lessens HIV transmission. However, the practice [as a preventive measure] is dangerous to advocate because it is not 100 per cent fool-proof, Mr Rao told Treat Asia, a journal which focuses on HIV-Aids in Asia. But many Aids researchers, like French expert Bertran Auvert, have come to the conclusion after extensive studies that male circumcision would reduce the risk of female-to-male transmission by 50 to 60 per cent.

In 2007, the World Health Organisation and UNAIDS recommended that male circumcision be recognised as an effectual preventive measure. Male circumcision must be recognised as an important means to fight the spread of HIV infection and the international community must mobilise to promote it, Mr Auvert strongly emphasised at a presentation; his 2005 study involving at least 3,000 African men is believed to be one of the most extensive yet.

HIV is a virus that leads to Aids, which primarily attacks the body's immune system causing it to gradually fail. This leads to increased susceptibility to otherwise common infections such as influenza which can become life-threatening.

There is currently no cure for the virus, frequently transmitted through the transfer of bodily fluids such as blood, semen, vaginal fluid and breast milk.

International health organisations estimate Aids has claimed more than 25 million people since it was first identified in 1981 and it is believed to be one of the worst pandemics in history. Regions such as Africa and South East Asia are known to be the worst affected, making up more than half of the world?s infected population.

Mr Rao noted that although most Asian nations had stepped up preventive measures such as condom promotion programmes, the disease was still spreading rapidly. Transmission among vulnerable groups ? sex workers, intravenous drug users (IDU) and men who have sex with men (MSM) ? was particularly rapid, he said.

Preventative methods only reached less than 20 per cent of these target populations especially in areas such as Thailand and Cambodia, Mr Rao added.

Different societal cultures also has to be taken into account when implementing such measures ? especially predominantly Islamic states such as Malaysia as the religion traditionally prohibits birth control.

He highlighted that a great deal of money has been spent on awareness programmes which have not created an adequate impact.

The important part is to have political will, and also to have adequate resources for a larger scale campaign [if we are to reach at least an 80 per cent coverage].

But there is a mismatch in the allocation of budgets. This needs to be corrected if we really want to have effective prevention strategies,? he explained.

Currently, an estimated 40 million HIV-positive patients face a major issue of costly second-line anti-retrovirals ? medicine which slows down the damage of the virus on the immune system thus prolonging a patient?s lifespan.

Generics [second-generation medication] are available in countries such as India but still at a high cost. I think governments just need to come up with different strategies to contain costs, such as using compulsory licenses or parallel importing, available under World Trade Organisation (WTO) terms. I think countries should look at the WTO flexibilities to make second-line anti-retrovirals available,? Mr Rao suggested.

Without anti-retrovirals, HIV patients have been known to develop Aids within eight to 11 years - it varies from individuals. Once diagnosed with Aids, the average Aids patient has been said to live up to nine months.

But perhaps the worst symptom of the disease is the stigma it carries due to the medium of which the disease is usually passed through — via sexual intercourse or drug use.

Vietnamese victim Jeanne D'Arc Truong is an example of a disturbing trend of individuals afraid to disclose their status as HIV positive. She told Treat Asia she learnt that her boyfriend had infected her in 2000 after a blood test.

When my results came back positive, I confronted my boyfriend. It made him miserable to feel like the culprit who signed my death sentence. In 2001, he died.

I disclosed my status to no one except my mother and I knew that the only way out was share my story, but it was difficult to be open about HIV. When I told my closest friend, she seemed sympathetic but later confessed her fear of coming into close contact with me or drink from the first glass,? the program officer of the USAID/Health policy Initiative in Vietnam confessed.

The WHO and UNAIDS have stated the biggest concerns now are these people, who are unwilling to disclose their statuses to their sexual contacts, knowingly infecting thousands more every year.

Countries such as diverse as Singapore, Russia and the United Kingdom have seen no other way out but to enact laws to prosecute HIV carriers who knowingly pass the virus on to others in a bid to stem the problem.

But experts say that such persecutions undermine efforts to stop the spread of the disease.

Deborah Jack, chief executive of the External link National Aids Trust in Edinburgh says: Stigma and discrimination around HIV is increasing as people living with HIV are cast as criminals, making it even more difficult for them to tell other people.

Prosecutions are undermining our efforts to encourage people to take responsibility for their own sexual health by implying it is the sole responsibility of the person living with HIV to have safer sex.


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