Studies Back Circumcision, but Obstacles Remain

Three studies have shown that male circumcision can reduce female-to-male HIV infection by 60 percent, but barriers remain to the procedure's adoption in Africa, where it would do the most good.

Circumcision itself is simple and getting simpler. Research shows nurses can perform it safely after three days of training, and it can be done assembly-line-style with devices requiring no scalpels or stitches. However, some countries forbid task-shifting from doctors to less-expensive medical workers. In Uganda, it would take an act of parliament to authorize nurses to do it, said Angelo Kaggwa, a Ugandan working with AVAC, an advocacy organization.

In addition, many ethnic groups have cultural traditions against male circumcision and, for adult men, healing requires sexual abstinence for six weeks. Since circumcision is only partially protective, preventive measures -- such as using condoms -- are still necessary.

Circumcision efforts are increasing in 14 African nations, where international health agencies hope to reach 80 percent of males ages 15-49 by 2015, or 20 million men. Just 1.5 million circumcisions have been conducted in the five years since the World Health Organization recommended the procedure in countries hard-hit by AIDS.

The costs are $65-$95 per procedure, in addition to about $60 for health system overhead.

Studies show men are willing, and circumcision uptake has boomed at trial sites: Of men not randomly assigned to be circumcised in a trial in Nyanza province, Kenya, 50 percent opted to have the surgery within five years after the study, and follow-up since shows it reduced their infection risk by 65 percent. In Orange Farm, South Africa, circumcision prevalence grew from 17 percent to 54 percent in the past three years. Researchers estimate HIV prevalence there would be 20 percent higher without such uptake, and that more than 1,000 infections were averted.

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