Male circumcision became officially endorsed as an HIV preventive measure for heterosexual men this week Wednesday by the World Health Organisation (WHO) and UNAIDS.
Countries with a high rate of heterosexually acquired HIV would be encouraged to promote male circumcision, the WHO and UNIADS announced at a press conference in Paris.
This follows “compelling evidence” from three trials — in South Africa, Kenya and Uganda — which found that male circumcision reduces the risk of heterosexually acquired HIV infection in men by between 51% and 60%.
Dr Kevin de Cock, WHO’s HIV/AIDS director, described male circumcision as “an additional intervention which can reduce the risk of HIV infection in heterosexual men”.
If male circumcision was introduced in sub-Saharan Africa, it could prevent 5.7 million new cases of HIV infection and three million deaths over the next 20 years, according to the two organisations.
But male circumcision was not a “magic bullet” that provided complete protection against HIV infection, warned De Cock.
While the trials showed that the HIV rate was “considerably lower” among circumcised men, these men could still become infected with the virus and, if HIV-positive, could infect their sexual partners.
“We must be clear: male circumcision does not provide complete protection against HIV,” stressed UNAIDS official Catherine Hankins.
“Men and women must continue to use other forms of protection such as male and female condoms, delaying sexual debut and reducing the number of sexual partners.”
This was necessary to “prevent men developing a false sense of security and engaging in high-risk sexual behaviours which could undermine the partial protection provided by male circumcision,” warned the WHO and UNAIDS.
The organisations acknowledged that the main reason for circumcision globally was religious, which meant that circumcision had to be promoted in a “culturally sensitive” manner.
They recommend that young men aged 12 to 30 should be targeted for circumcision, as well as older men with a history of sexually transmitted infections.
Further research is needed to see whether male circumcision reduces the sexual transmission of HIV from men to women or between men who have sex with men.
In addition, circumcising HIV positive men was not recommended unless there was a medical reason as “people with severe immunodeficiency may have increased complication rates following surgery”.
Earlier this month Dr Nomonde Xundu, head of the health department’s HIV/AIDS programme, said that although government had seen reports on male circumcision, it wanted to study the research further before deciding on whether to change government policy.
by Kerry Cullinan