Great debate may slow circumcisionists push

Cautious voices have said all along that trumpeting male circumcision as a prevention strategy against HIV infection mixes messages and feeds confusion. Such confusion therefore threatens gains made by the unified message of safer sexual practices, abstention from or rehabilitation for intravenous drug use, drug use harm reduction (needle exchange) and knowing your HIV status.

Now leaders in Africa are getting in on the debate and echoing this stance. President Yoweri
Museveni recently joined the “heated” Ugandan national debate, arguing that the findings could hurt the fight against the pandemic.

Dr Godfrey Kigozi, one of the researchers in the Ugandan study, has said, “When you say circumcision reduces acquisition … it does not mean it eliminates HIV/AIDS. It is just one component in our arm of prevention. If you are circumcised, then it is fine, but if you practice safe sex or abstain [that is] better.”

The essential message is that you cannot depend on circumcision to protect you. Therefore, don’t circumcise solely for the purpose of reducing your risk. Anything more nuanced, such as, “if you occasionally engage in unsafe sexual practices, get circumcised to
reduce the one-off chance you will be infected,” is hopelessly confusing and unhelpful. In any event, opponents argue that the disadvantages and longterm damage to sexual function obviously would detract from such an approach, nuanced or not, as it could lead to more frequent unsafe sexual activity.

Uganda continues to mull over the findings of the studies promoting circumcision as a risk reduction procedure.

Click through for the full text of the article.

UGANDA: Findings on circumcision may derail HIV/AIDS fight – President

KAMPALA, 12 February (PLUSNEWS) – Recent findings that male circumcision
reduces the risk of contracting HIV have generated a heated national
debate, with President Yoweri Museveni arguing that the findings could
hurt the fight against the pandemic.

“These days, there are many confusing messages: one of them is that if you are circumcised, you are less likely to catch AIDS even if you behave recklessly – now what sort
of message is that?” the president said recently, adding that such messages sent the wrong signal to the people and caused apathy in the fight against HIV/AIDS.

In December 2006, the National Institute of Allergy and Infectious Diseases in the United States, part of the National Institutes of Health, announced an early end to two clinical
trials investigating the effects of adult male circumcision after an interim review of the data revealed that medically performed circumcision significantly reduced a man’s risk of acquiring HIV from having heterosexual intercourse.

The trial involved almost 3,000 HIV-negative men in Kisumu, western Kenya, and showed a 53 percent reduction in contracting HIV among those who were circumcised, while a
trial with about 5,000 HIV-negative men in the Rakai District of central Uganda showed that HIV acquisition fell by 48 percent in circumcised men.

Dr Godfrey Kigozi, one of the investigators in the Ugandan study, told IRIN/PlusNews that the study highlighted the protective effect of male circumcision on transmission of the virus, but emphasised that it did not remove the risk altogether.

“When you say circumcision reduces acquisition … it does not mean it eliminates HIV/AIDS,” Kigozi said. “It is just one component in our arm of prevention. If you are circumcised, then it is fine, but if you practice safe sex or abstain [that is] better.”

Museveni argued that Uganda’s success in controlling HIV/AIDS was because of the clear
message his government has sent. “The way we controlled AIDS was because of an unequivocal message that there is a sickness which is not curable, you get it through sex, and when you get it you die. Therefore, avoid all risky sexual behaviours,” he said.

Addressing the nation at celebrations in the capital, Kampala, to mark 21 years of
his rule on 26 January, Museveni advised young people to abstain from sex until they had found a partner for marriage. “I am worried that HIV infection rates have started to rise, and people think that HIV is no longer there,” he said. “Abstain until you get a permanent
partner. You have to know that the ARVs [antiretrovirals] don’t cure but only prolong your life.”

Museveni’s government has been credited with reducing HIV prevalence in Uganda from over 20 percent in the early 1990s to about six percent by 2000. However, there was a
marginal rise in prevalence from 6.4 percent in 2005 to 6.7 percent in 2006: a trend some analysts have blamed on complacency and wide use of the life-prolonging drugs.

Dr Sam Okware, director of health services in the health ministry, told PlusNews that the ministry was still assessing the findings on male circumcision to see how they could be factored into the country’s general prevention strategy.

Staff Writers. UGANDA: Findings on circumcision may derail HIV/AIDS fight – President. IRIN PlusNEWS. February 12, 2007.

http://www.plusnews.org/AIDSreport.asp?ReportID=6702&SelectRegion=East_Africa&SelectCountry=UGANDA

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One Response to Great debate may slow circumcisionists push

  1. TLC Tugger says:

    This whole discussion is obscene. Amputation has no more of a role in HIV prevention than it does in tooth decay or ovarian cancer. 80% of the world is not circumcised and suffers no special health, hygiene, social problems.
    In Malawi, Tanzania, Ghana, Rwanda, Lesotho, and Cameroon, HIV is most prevalent among the circumcised. 450,000 US men who were cut at birth have died of AIDS. Circumcision does not prevent AIDS.
    A U.N. condom costs 3 cents to give away. How many could one buy for the price of a medicalized circumcision?

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