Business Day (Johannesburg)

8 February 2008

South Africa: Minister Breaks Bad News About Aids Prevention

Cape Town — Health Minister Manto Tshabalala-Msimang expressed doubts yesterday about the merits of male circumcision in preventing HIV transmission, saying new research suggested the procedure might make women more vulnerable to the disease.

Last year the World Health Organisation (WHO) recommended that countries hard-hit by HIV/AIDS encourage male circumcision, after three large studies showed it could halve the risk of men getting the virus from infected women.

"I've just had very shocking news this morning," the minister told traditional leaders gathered in Cape Town to debate male circumcision ahead of a WHO meeting in Brazzaville in April.

She told reporters later she had been informed by local scientists Gavin Churchyard and Glenda Gray of new research indicating that women who had sex with circumcised HIV-positive men appeared to be at greater risk of infection than women who had sex with uncircumcised men.

Prof Churchyard, who heads the Aurum Institute for Health Research, said that research presented at the 15th Conference on Retroviruses and Opportunistic Infections in Boston this week indicated circumcising HIV-positive men might increase the chance of harm to women. There were "incredibly high" rates of HIV transmission in the first six months after circumcision, probably because the men were having sex before their wounds had healed, he said.

The research had important public health implications, as it meant a mass circumcision programme would have to be coupled with HIV testing, said Churchyard. "Circumcision reduces the risks for uninfected men, so it would have an overall effect on the population, and women could still benefit indirectly."

The study presented at the conference was carried out in Uganda and funded by the Bill and Melinda Gates Foundation. It compared the annual HIV incidence in the wives of men who had been circumcised to wives of men who had not.

According to media reports and a video recording of the presentation, the annual HIV rate in the wives of the men who had been circumcised was 14,4% over two years, compared to 9,1% among the women whose husbands had not been circumcised. The researchers emphasised that the results could have been due to chance, as the findings were not statistically significant.

AIDSmap reported the study's principal investigator, Maria Wawer of Johns Hopkins University, as saying the results were "unexpected and somewhat disappointing". If the results were not due to chance, they might be due to men having sex before their circumcision wound had healed. Both groups reported the same level of condom use. Wawer said the results posed a challenge to the mass roll-out of male circumcision in Africa.

The results were "not good, not good at all," said the health department's HIV/AIDS head, Nomonde Xundu.

The president of the Southern African HIV Clinicians Society, Dr Francois Venter, said the minister was "right to be concerned ".

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