East and Central African economies could save up to $20 billion in the cost of Aids programmes over the next 15 years by scaling up the voluntary male circumcision programme.
The savings would result from the circumcision of up to 80 per cent of adult and newborn males in 14 countries in the region.
The savings in funds for Aids programmes in these countries that include Kenya, Uganda, Tanzania and Rwanda would result from a significant reduction in adult HIV infections between 2009 and 2025, estimated at over four million.
However, this would only be achieved if 12 million male circumcisions on newborns and men aged between 15 and 49 years are performed in 2012, which has been designated 'peak year', followed by an average of between four and five million cuts between 2015 and 2025.
The enhanced male circumcision programme would require an investment of US$2.5 billion between 2009 and 2025.
This includes an additional US$420 million in the peak year (2012) and US$125 million annually from 2015.
The brief projects that this would translate into annual cost savings of between US$1.4 and US$1.8 billion after 2015, which would accumulate to over US$20 billion by 2025.
Male circumcision is presently regarded as one of the strategies for controlling HIV/Aids. Several studies have found out that circumcised males have a comparatively lower risk of contracting the HIV/Aids virus.
A recent study published in the Public Library of Science (PLoS) Medicine attributed this to the removal of the 'vulnerable' foreskin.
This followed trials that were conducted in Uganda, which suggested that circumcision reduced a man's risk of acquiring herpes and other conditions that cause genital sores, hence HIV/Aids.
The latest policy brief is an attempt to promote the wide adoption of male circumcision in East and Central Africa in order to tap into its health benefits.
Titled 'The Potential Cost and Impact of Expanding Male Circumcision in 14 African Countries' it was prepared by the World Health Organisation, the Joint United Nations Programme on HIV/Aids (UNAids) with input from the United States Agency for International Development (USAid), the US Centres for Disease Control and Prevention (CDC) and the Office of the US Global Aids Co-ordinator.
It has developed estimates for the scale ups in individual countries, as well as the corresponding outcome.
In East Africa, Rwanda, whose HIV/Aids prevalence rate stands at 2.8 per cent and has the lowest circumcision rate of 10 per cent, requires the highest investment to enhance its male circumcision programmes to meet the 80 per cent target.
An additional US$32 million over the current male circumcision expenditure levels is required.
This will yield savings of up to US$200 million in the next 15 years.
Tanzania and Uganda require an additional investment of US$20 million and US26 million Debusmann is an international columnist.respectively into their male circumcision programmes.
The policy brief calling for an enhancement of the Hiv/Aids programme comes as Kenya, which has had a successful male circumcision programme running in one of its regions, Nyanza Province, concludes an accelerated circumcision drive that targeted 30,000 males in a month.
"We are pleased that so many men sought voluntary circumcision and that our health workers were able to meet that demand in such a short time," said Nyanza provincial commissioner Francis Mutie.
The male circumcision programme is being run in Nyanza Province, whose Hiv/Aids prevalence rate stood at 14.9 per cent against the national figure of 8.7 per cent, according to the 2007 Kenya AIDS Indicator Survey (KAIS).
The province also had low male circumcision rates of 48 per cent, compared to the country's average 85 per cent. It requires US$2 million to scale up, probably due to the comparatively smaller area of coverage.
Kenya is also way ahead of the other countries in its male circumcision programme. So successful has been the programme in Kenya that several African countries have sent delegations to draw from her lessons.
The programme has performed up to 75,000 cuts since its launch in November 2008, raising hopes that the procedure could gain acceptance among the non-circumcising communities.
"If Nyanza meets that goal, an estimated 900,000 HIV infections could be prevented, among men and women, over 20 years," said Dr Mores Loolpapit a senior manager with the male circumcision consortium that implements the national cut strategy in conjunction with the government. The cut has gained wide acceptance since last year after Prime Minister Raila Odinga, came out in support of the medical procedure.
So far, four African countries have sent delegations to learn firsthand from the experience of the country's voluntary medical male circumcision.
A statement from the Male Circumcision Consortium indicated that in October, Kenya played host to teams of health officials from Botswana, Swaziland, Tanzania, and Mozambique
A visit by delegations from four other countries that was planned for this month was put off. The visit is scheduled for next year.
If adopted, the scale up promises to further improve its implementation.
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The majority of men who are HIV positive become infected through the penis during sexual contact. Recent studies have proven conclusively that uncircumcised men are at a much greater risk of becoming infected with HIV than men who are circumcised. In some studies, infection rate was 50 percent less in circumcised men. source: http://simplestdtesting.com/resources/
Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.
ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
The figures given in this article are all sheer speculation. They rely on a number of assumptions, notably that mass circumcision will have the same effect as the three randomised (non-blinded, non-placebo-controlled) trials, which may (or may not) have protected no more than 73 men for less than two years, after circumcising 5,400 men. On this slender edifice (a veritable Burj Dubai of speculation) are the claims of "billions and billions" built. Women are more at risk than men, yet the only trial of male-female transmission was halted when it was starting to show that circumcision might increase the risk.
This is wasted speculation as the real world does not provide the risk change that is claimed by the US circumcision pushing researchers.
The Africa male circumcision trials ALLEGE a HIV risk change that is minimal (3.2% to 1.78% risk). That is a small risk change while women are MORE at risk. A condom is still needed for unsafe sex.
The alleged 60% HIV risk change (3.2% risk to 1.78% risk) is not found elsewhere. Let us put aside the propaganda numbers game in which 60% was never actually realized and 60% is really 1.79% risk change still leaving high risk. The fact that the "trials" data are at odds with real world data should set off an alarm. The "trials" have many flaws as have been noted by the critics but ignored by the WHO and others (loss of more cut men than the number that got HIV -- their status would change the outcome, the cut did not have sex during large part of trial, condom advice was given to the cut men, no real understanding of the sexual practices nor the change in behavior caused by amputation of part of the penis). A real glaring flaw and issue is the fact that real life data does not show the 1.8% risk change alleged from the trials. Besides the curious fact that Europe and Japan have low circumcision rates and low HIV rates and the US has high circumcision rates and high HIV rates, in the US and other places there is no correlation between HIV risk change and circumcision. Take for example the study Prevalence of Circumcision and its Association With HIV and Sexually Transmitted Infections in a Male US Navy Population with the Conclusions: Although known HIV risk factors were found to be associated with HIV in this military population, there was no significant association with male circumcision. Look also to the fact that the Africa trials (Kenya and Uganda) were done by Americans desperately trying to push circumcision. Did they tell HIV positive men that were circumcised to get LOST? Someone must at least look into this before using their data, hundreds of circumcised were lost! Is this not a flag then that the discord with the real world must imply a fraud, a lie, fudging the numbers? The real world should show the same 1.8% risk change and it does NOT.