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Commentary & Opinion
Male Circumcision a "Staggeringly Under-Utilized Tool"

March 21, 2013

"PrePex, the new nonsurgical circumcision tool experts believe could revolutionize the prevention of HIV and AIDS in sub-Saharan Africa, is easier to assemble than a toy you might find in a Happy Meal," freelance journalist Patrick Adams writes in the New York Times' "Opinionator" blog. "Recent studies in Rwanda indicate that the device, which induces necrosis of the foreskin by blocking its blood flow, can be used to cheaply, quickly and safely circumcise adult men in resource-limited settings -- places where surgeons are scarce and where, five years after circumcision's protective efficacy was first proved, millions of men are still in need of the procedure," he writes. "Since 2007, health authorities have known that circumcising adult men reduces their risk of acquiring HIV through heterosexual intercourse by 60 percent or more," he states, noting, "That landmark finding, firmly established by dozens of observational studies and three randomized controlled trials in South Africa, Uganda and Kenya, has made male circumcision the most promising method of prevention in the anti-AIDS arsenal."

"And yet, for all of its obviousness, male circumcision remains a staggeringly under-utilized tool," Adams continues, noting, "As of late 2011, a mere 1.3 million medical male circumcisions had been performed in sub-Saharan Africa ... well short of the target set by the World Health Organization and the Joint United Nations Program on HIV/AIDS (UNAIDS): 20 million men, ages 15 to 49, by 2015." He writes, "PrePex, which is approved by the Food and Drug Administration and is pending approval by the World Health Organization, has the potential to close that gap," but "questions linger about the potential for what public health scholars call the Achilles' heel of HIV prevention: a phenomenon known as 'risk compensation,' whereby a decrease in perceived risk results in an increase in risk-taking behavior." He adds, "That's not to say circumcision shouldn't be a top priority in the fight against HIV /AIDS in Africa; every intervention has its trade-offs, and male circumcision is no exception" (3/20).

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