Kakaire a Kirunda
30 June 2008
Evidence, which might convince President Museveni to support male circumcision as one of the HIV infection prevention strategies, has emerged.
Mr Museveni has repeatedly dismissed research that male circumcision offers a 60 per cent reduction to men against acquiring HIV.
Officiating at the HIV implementers programme meeting in Kampala in early June, President Museveni reiterated that he has got no scientific and practical evidence regarding circumcision in HIV control.
Some public health advocates with the same reasoning as Mr Museveni have been reluctant to endorse circumcision for fears that its benefits will lead to increased risk behaviour by men who perceive that their risk of HIV has been reduced.
Since studies in Uganda, South Africa and Kenya confirmed that male circumcision significantly reduces acquisition of HIV-1 infection among men, Ugandan scientists have tried in vain to woe President Museveni to promote the practice as one of the strategies to contain new infections.
However, given the fears, researchers in Kisumu in neighbouring Kenya reportedly sought to perform a comprehensive, prospective evaluation of risk compensation, comparing circumcised versus uncircumcised controls in a sample of randomised control Trial participants.
According to their findings published this month in the journal PLoS one, "We found no evidence to suggest that circumcised men engaged in increased risk behavior after the procedure," the findings read in part. "To the contrary, both circumcised and uncircumcised men significantly reduced their HIV risk behavior from baseline to the 6 and 12 month follow-up visits."
However, just as the Uganda Aids Commission has argued, the researchers urged the HIV prevention community to ensure that "male circumcision services are integrated with a full package of HIV prevention measures.
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I agree with Hugh totally on the merits of his argument, although I have not read the study. In addition to the argument he gives, is anyone looking at the circumcision may be performed? In the real world out here (I'm writing from southern DRC), a major campaign to circumcize sizable numbers of men would most likely lead to abuses -- informal circumcisions performed by cheaper providers in neighborhoods, etc. The risk of the disease and even the death rates among those circumcized is, from my perspective of living and working throughout Africa for 40 years, very great. Already,… [Read Full Text]
If you read the actual paper, you find that "both circumcised and uncircumcised men significantly reduced their HIV risk behavior from baseline to the 6 and 12 month follow-up visits." The fact that the NON-circumcised men ALSO changed their behaviour clearly shows that it was not circumcision that did it, but just the effect of being in an experiment, getting a lot of attention (the "Hawthorne effect"). In the real world, we have heard many stories suggesting circumcised men will think they are immune and abandon safer sexual practices.
One of the authors of this research is Robert Bailey. He… [Read Full Text]