New York Times, Baltimore Sun Examine Increasing Practice in Southern Africa of Male Circumcision To Prevent HIV Transmission

The New York Times on Friday examined the increasing practice in Southern Africa of male circumcision, which can be a "simple and possibly potent weapon" against HIV transmission (LaFraniere, New York Times, 4/28). A study published in the November 2005 issue of PLoS Medicine of men living in South Africa finds that male circumcision might reduce the risk of men contracting HIV through sexual intercourse with women by about 60%. Male circumcision also might reduce the risk of HIV transmission from HIV-positive men to their female partners, according to a study of couples in Rakai, Uganda (Kaiser Daily HIV/AIDS Report, 4/25). Some health workers in Zambia and Swaziland are working to widen access to circumcision to meet what they call a "burgeoning demand" for the procedure, the Times reports. In Zambia, surgeons at the University Teaching Hospital in Lusaka began offering the procedure for roughly $3 about 18 months ago. About 400 people request circumcision at the hospital every month, eight times as many as the facility can perform, according to Kasonde Bowa, a urologist at the hospital. Surgeons at the hospital are calling for the government to make the procedure available nationwide. In Swaziland, the Ministry of Health and Social Welfare in January sponsored a workshop to train 60 doctors in the procedure after demand for circumcision spiked (New York Times, 4/28). According to the Baltimore Sun, after a health advocacy group in Swaziland promoted no-cost circumcisions for one day in January at a clinic, "stunned doctors had to hand out circumcision rain checks to pacify the shoving, yelling crowd" (Goering, Baltimore Sun, 4/28).

Caution
Some policy makers are "holding back" enthusiasm about circumcision as an HIV prevention tool until the World Health Organization endorses it, the Times reports. WHO officials say the evidence about circumcision is not definitive enough to include the procedure in HIV prevention methods, and they are reluctant to recommend the procedure until the results of two trials in Kenya and Uganda are released. The results of the trials, involving 8,000 people, could be released by the end of June, according to the Times. WHO officials also say that even if the studies confirm that male circumcision prevents HIV transmission, the procedure still would have to be used in conjunction with other prevention strategies, including testing, condom use, faithfulness to one partner and abstinence until marriage. In addition, some advocates are concerned that the studies might lead people to undergo unsafe circumcisions by traditional healers (New York Times, 4/28).