AFRICA: Fears circumcision could spread HIV borne out by research

A common fear expressed by UNAIDS and WHO regarding male circumcision has been that the procedure will spread infection both directly through contaminated instruments and by “risk disihibition” – men thinking circumcision has made them immune. This article summarizes recent research which backs up this fear and implicitly posits the very real likelihood that female circumcision will march close behind  male circumcision, perhaps in places where it hadn’t before (although it doesn’t explicitly state this latter point or discuss it).

Story after the break.

FGM, circumcision “likely to spread HIV”

New research dramatically contradicts the popular conclusions of recently published reports, holding that male circumcision protects against contracting AIDS. Scientists looking at male circumcision and female genital mutilation (FGM) practices in Kenya, Lesotho and Tanzania found that the cut in itself was causing many new AIDS cases among adolescents.

The research, published in the March issue of the scientific journal ‘Annals of Epidemiology’, was carried out by a team of researchers led by Devon Brewer, director of the research firm Interdisciplinary Scientific Research. “We found that circumcised virgins and adolescents in Kenya, Lesotho, and Tanzania were consistently and substantially more likely to be infected with HIV than their uncircumcised counterparts,” Mr Brewer said.

The researchers analysed data from the ‘Demographic and Health Surveys’, which are based on nationally representative samples of adolescents and adults. In the three African countries studied, circumcision is typically performed in adolescence or early adulthood
and often in unhygienic circumstances where many individuals are circumcised with shared, unsterilised cutting instruments.

“Sexually experienced male adolescents were no more likely to be infected than adolescent virgins, further highlighting how HIV may be spreading by means other than sex,” the researchers concluded. Mr Brewer said “a key problem with nearly all prior research on circumcision in Africa is that researchers have treated circumcision only as an anatomic characteristic, and not also as a potential exposure to others’ blood during the circumcision operation.” He continued, “this is striking, because over the last 20 years, many Africans, including children, have warned that HIV can spread through circumcision procedures.”

The new results in particular raise questions about how to understand the recent randomised trials of male circumcision in South Africa, Kenya, and Uganda. These studies, in which some uncircumcised men were randomly assigned to be circumcised in presumably sterile conditions and others were not circumcised, showed that male circumcision reduced HIV acquisition.

The popular news reporting of these findings has been widespread in Africa. And the basic message in African media has been that circumcising young boys – and sometimes girls – will protect them from contracting HIV-AIDS. The new study however shows that this conclusion is not only wrong, but also a dangerous message, due to the poor hygienic standards normally applied at circumcision ceremonies.

Mr Brewer said, “If we had known several years ago what we know now from the national surveys, there would not have been a good empirical basis even to conduct the trials. Therefore, it is crucial to investigate thoroughly the possible mechanisms – which are speculative at this point – for the protective effect observed in the trials.”

The US researcher and his colleagues finally called for more intensive study of HIV transmission in the context of both traditional and medical circumcision in sub-Saharan Africa.

Reference

Staff writers.  FGM, circumcision “likely to spread HIV”. afrol News. February 26, 2007.

http://www.afrol.com/articles/24469

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