Brazil rejects circumcision

This is old news in that it has been reported elsewhere around the web. Nevertheless, I provide the full story and a translation from the Spanish below.

Generally, the reasons given for Brazil’s rejection of circumcision as a public health measure, apart from not fitting the profile of a country that UNAIDS and WHO are encouraging to consider the measure, are the following:

  • circumcision only provides one-way protection, from female to male (partial protection in more ways than one)
  • circumcision has the very real danger of providing a false sense of security, thereby causing a drop off in the use of better prevention technologies, aka the condom

I would add another reason. Circumcision damages the penis and has the proven potential to cause sexual dysfunction. Therefore, it should be a last resort in highly impacted populations. Did this idea have some traction at the high-level meeting that produced the WHO and UNAIDS recommendations in that only countries with an infection rate of 15% or more are to be encouraged to consider the measure? Or is it more likely a cost ($$) benefit analysis was the true basis for limiting the recommendation to such countries?

Original article and my translation after the break.

Brasil rechaza recurrir a la circuncisión como método preventivo contra la transmisión del sida

Brazil rejects resorting to circumcision as a method to prevent the transmission of HIV

  • Así lo afirma un estudio de la OMS. A WHO study affirms [the approach].
  • Sólo evita la transmisión de mujer para hombre y no lo contrario. It only avoids transmission from women to men and not the other way around.
  • Brasil tacha la medida de “falsa prevención” y prefiere seguir aconsejando el uso del condón y promover entregas gratuitas de anti-retrovirales. Brazil scratches the measure of “false prevention” and prefers to continue counseling the use of the condom and promoting the provision of free anti-retrovirals.

Brasil no tiene previsto adoptar la circuncisión como práctica de salud pública para evitar la propagación del virus del sida, afirmó una responsable del área al criticar la supuesta efectividad de esta técnica contra la epidemia.

Brazil does not anticipate adopting circumcision as a public health policy in the prevention of HIV infection, an expert in this area of prevention affirmed.

Un informe reciente de la Organización Mundial de Salud (OMS) recomendó recurrir a la circuncisión generalizada en algunos países como forma de combatir el contagio del virus, después de que estudios llevados a cabo en África indicaran que la cirugía ayuda a fortalecer la piel del glande y a crear una barrera natural contra el virus HIV.

A recent bulletin of the World Health Organization (WHO) recommended resorting to a generalized circumcision campaign in some countries as a way to combat HIV infection, after a study carried out in Africa indicated that the surgery helps strengthen the skin of the glans and creates a natural barrier against the HIV virus. [In fact, this is in error. The mechanism was not studied and has so far garnered only speculation as to how it works.]

Para la asesora técnica del programa nacional del sida del Ministerio de Salud de Brasil, Mariángela Simao, uno de los problemas es que, según los estudios, la cirugía para retirar la piel del prepucio sólo evita la transmisión de mujer para hombre y no lo contrario, según la estatal Agencia Brasil, de información.

For the Brazilian Health Minstry’s technical advisor for the national HIV program, Mariangela Simao, one of the problems is that, according to the studies, the surgery to remove the foreskin only avoids transmission from the female to the male and not the other way around, according to the state Brazilian Information Agency. [Again, incorrect. It did not prove prevention. Rather it purported to show a lowered risk.]

Es decir, que sólo los hombres estarían protegidos, dijo la experta, al observar que tampoco hay datos que comprueben la disminución de la transmisión del virus HIV entre homosexuales.

That is to say that only men would be protected, said the expert, while observing that neither study proved a lowered rate of transmission of the virus between homosexuals.

Según la OMS, la circuncisión como arma contra el sida sólo es aplicable en países donde la epidemia alcanza a más del quince por ciento de la población, y en ese contexto quedan excluidos los países de América Latina, entre ellos Brasil, donde la epidemia alcanza al 0,06 % de los habitantes.

According to the WHO, circumcision as a weapon against AIDS is only applicable in countries where the epidemic has reached a level greater than 15% of the population, and in this context, Latin American countries are excluded, including Brazil, where the epidemic has reached 0.06% of inhabitants.

“Encuentro un poco sorprendentes y hasta temerarias esas recomendaciones de la OMS y del Programa de las Naciones Unidas para el HIV/sida”, dijo Simao a la Agencia Brasil.

“I find these recommendations of UNAIDS and WHO a little surprising and frightening,” Simao told the Brazilian Agency.

“El estudio tiene un potencial de salud pública muy enfocado“, agregó.

The study has a very focussed public health potential,” she added.

Esa propuesta transmite un mensaje que puede ser “hasta de falsa protección“, pues los hombres podrían pensar que si están circuncisos pueden tener relaciones prescindiendo de los preservativos sin correr ningún riesgo, lo cual “no es verdad“, observó.

That proposition sends the message of “false protection,” in that men can think that if they are circumcised they can have sex, foregoing condoms without running any risk, when “it isn’t true,” she observed.

Simao dijo temer que los recursos de los países desarrollados que hoy son destinados al tratamiento de la enfermedad sean re-dirigidos para cirugías de circuncisión en los países donde la técnica es recomendada.

Simao said she fears resources from developed countries that are now destined for treatment of the disease may be redirected to circumcision in the countries where the procedure is being recommended.

El programa brasileño de prevención y combate al HIV/sida incluye campañas de información, distribución gratis de preservativos y atención gratuita a los enfermos con entrega de medicamentos  anti-retrovirales.

The Brazilian HIV/AIDS prevention program includes information and condom distribution campaigns and free [medical] attention to the sick with free provision of antiretroviral medications.

Esta política de salud pública ha sido reconocida por la Organización de Naciones Unidas, ONU, y es aplicada a otros países en desarrollo.

This public health policy has been recognized by the United Nations, and is applied in other developing countries.

Reference

Staff reports. Brasil rechaza recurrir a la circuncisión como método preventivo contra la transmisión del sida. 20minutos.es. April 3, 2007.

http://www.20minutos.es/noticia/219548/brasil/contra/circuncision-preventiva/

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