[Note: Seven years later, the problem discussed below is still a problem. Unsterile instruments spreads HIV in all types of surgeries in Africa. The addition of circumcision has made the problem worse.]
This important article was published a few weeks back. Sorry I’m just now getting around to posting it.
The article speaks for itself and demonstrates the major obstacles in introducing circumcision in a developing country. As important is the issue it raises concerning circumcision in countries where the procedure is a cultural tradition.
IHT article after the break.
In Africa, a problem with circumcision and AIDS
ROME: Unsterile circumcision is a potentially important route of HIV infection among children and adolescents in Africa, a new study suggests.
The report is likely to intensify a debate about the proper role of circumcision in Africa’s HIV epidemic, because large, recent studies suggested that circumcision, if performed using sterile techniques, could be a powerful tool for preventing infection in males.
By examining large national data samples of young people who had never had sexual intercourse in Kenya, Tanzania and Lesotho, researchers from Interdisciplinary Scientific Research, a research firm based in Seattle, found that virgin males who had been circumcised were two to three times more likely to be HIV positive than those who had not had the procedure.
The data, published in the March issue of the Annals of Epidemiology, expand scientific understanding of the spread of HIV in Africa. In some African countries, more than 20 percent of adults are infected, and while sexual transmission is by far the most common means of transmission, it has become increasingly clear that other routes spread the disease as well.
Last week, two studies published in the journal Lancet concluded that medically supervised circumcision offered men powerful protection against HIV, reducing the rates of infection by 50 to 60 per cent. As an example, circumcision could prevent 35,000 new HIV infections in South Africa’s KwaZulu-Natal Province in 2007, a commentary in The Lancet said.
Dr. Kevin De Cock, head of the World Health Organization’s HIV/AIDS department. called those studies an “extraordinary development” and circumcision a “potent intervention in HIV prevention.”
But in a interview by telephone Monday De Cock said: “We’ve always known that unsafe medical procedures can transmit HIV. There will need to be lots of discussion of how to ensure safety.”
In each of the two Lancet trials, one in Kenya and one in Uganda, sexually active adult men were offered circumcision by a physician and then followed for two years.
The trials were stopped in December when scientists realized that the men who had been circumcised were far less likely to acquire HIV.
The conclusions were so compelling that the World Health Organization will convene a meeting of experts in March to discuss the idea of initiating widespread circumcision programs in Africa.
The study in Annals of Epidemiology highlighted the on-the-ground barriers that such plans may face: in poor countries, the procedure is often performed by nonmedical personnel, under unsterile conditions. Instruments that have been used on many children may still contain traces of blood and virus that can be passed from one patient to the next.
In the 1970s, for example, a circumcision campaign in India was halted after many patients suffered life-threatening infections or disfigurement.
“The greatest concern is that the push toward mass circumcision could facilitate and promote HIV transmission if it is not done properly,” said Devon Weber, author of the paper in the Annals of Epidemiology.
Rosenthal, Elisabeth. In Africa, a problem with circumcision and AIDS. International Herald Tribune. February 26, 2007