Health& Living

While there is high demand for circumcision services, it is not known how many men are undertaking the surgical procedure as part of efforts to reduce new HIV infections in the country, which stand at an annual average of 130,000.

When three scientific studies in South Africa, Kenya and Uganda produced the same findings in 2007 that medical male circumcision reduces by 60 percent the chance of HIV infection in men, UNAIDS and the World Health Organisation asked countries to use it in combination with pre-existing measures such as ABC (Abstinence, Being faithful and Condom use). Recent research has also added treatment and pre exposure prophylaxis using antiretroviral therapy among discordant couples to the current prevention arsenal.

It however emerged recently at a meeting in Kampala of the Safe Male Circumcision (SMC) National Task Force, that most of the institutions carrying out circumcision don’t share their data with the ministry of Health. According to the commissioner for National Disease Control, Dr Alex Opio, it is not possible to quantify the number of procedures due to lack of a comprehensive national report.

“During supervision visits, I have found that while circumcision is happening in very many places the data is not being shared,” he said. “And as national chairperson, I do not have a single figure on the great work being done. We need to address this immediately and at least share some data on who is being circumcised, location, age group and adverse events after the surgery, if any.”

Globally, use of data for evidencebased programming is increasingly taking centre stage in public health interventions. And with modelling studies showing what targets Uganda needs in the next five years, monitoring of data will be of significant importance. In the case of Uganda for instance, 4.2 million adult/adolescent men need to be circumcised in five years to avert 340,000 new HIV infections by 2025.

However, with most circumcision programmes funded using foreign aid -now on a downward spiral – there are sustainability challenges. For example, given a decrease in funding during the August - November period, Bugiri hospital did not offer any circumcision services. This was similar in Kamuli. As a possible mitigation measure, several speakers agreed that there is need for integrating circumcision services in the health system to ensure sustainability.

But according to the UNAIDS Country Representative in Uganda, Musa Bungudu, the predicament should be an opportunity for African countries to rethink national funding priorities. “This very week, together with colleagues from the ministry of Health and Uganda AIDS Commission, we met parliamentarians and asked them how they could help. Their answer was that we present a costed plan. That is all they need and take it from there.”

At the recent 16th international conference for AIDS and STIs in Africa, five international organisations launched a strategic framework for action to spur and coordinate efforts to circumcise 20.3 million men in 14 countries including Uganda in eastern and southern Africa by 2015. This was prompted by modelling studies that suggest that reaching, and then maintaining, 80-percent male circumcision coverage among men ages 15 to 49 years in these countries would prevent 3.4 million new HIV infections by 2025, saving an estimated $16.5 billion in HIV treatment costs.

The World Health Organization, the Joint United National Programme on HIV/AIDS, the US President’s Emergency Plan for AIDS Relief, the Bill & Melinda Gates Foundation, and the World Bank developed the framework in consultation with national ministries of health.

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Comments

 
+2 #1 Mark Lyndon 2012-01-12 00:17
From the USAID report "LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS"
"There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."

The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".

From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
"the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."
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+3 #2 Mark Lyndon 2012-01-12 00:21
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:

ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
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+2 #3 Tom Tobin 2012-01-12 01:25
Let's use some simple logic.
If circumcision protected anyone from HIV infection, wouldn't it stand to reason that Ethiopia would have a low HIV infection rate?

Almost 100% of Ethiopian men are circumcised. What is its HIV infection rate? At 2.1 percent of the population, it is high. What about the US. Nearly 80% of adult men are circumcised. Its HIV infection rate is .60 percent.

Six times higher than Finland or New Zealand, where they don't circumcise routinely at all. Studies in Malawi are showing that the most heavily circumcised areas have the fastest growing rate of infection. There is a reason that the WHO backs circumcision. Their chief expert, Dr. David Tomlinson, invented 3 circumcision clamps.
Here Dr. Tomlinson is in an ad:
http://www.kentecmedical.com/media/document/AccuCircWorkshopBrochure.pdf
Condoms, HIV education, and being faithful work
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+2 #4 Ron Low, Chicago 2012-01-12 01:57
Most of the US men who have died of AIDS were circumcised at birth.

Condoms are the most efficacious intervention to prevent HIV transmission during sex.
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+2 #5 PJ 2012-01-12 02:19
“What does the ... “60% relative reduction” in HIV infections actually mean? Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive.

Among the 5,497 controls, 137 (2.49%) became HIV-positive”, so the absolute decrease in HIV infection was only 1.31%, which is not statistically significant.” (Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011; 19:316-34.)

http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

The one randomized controlled trial into male-to-female transmission showed a 61% higher
rate among females in the group where the men had been circumcised. See:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
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+2 #6 PJ 2012-01-12 02:20
From the USAID report "LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS:
EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS"- Findings from the 18 countries with data
present a mixed picture of the association between male circumcision and HIV prevalence
(Table 9.3) . . . In 10 of the countries—Camer oon, Guinea, Haiti, Lesotho, Malawi, Niger, Rwanda, Senegal, Tanzania, and Zimbabwe—HIV prevalence is higher among circumcised men.”
(page 109) See:

http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
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+2 #7 Ronald Goldman, Ph.D 2012-01-12 07:16
Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. They have various flaws. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Authorities that cite the studies have other agendas including political and financial.

Circumcision causes physical, sexual, and psychological harm. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Please see http://www.circumcision.org/hiv.htm for more information and links to literature.
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