• Male circumcision and HIV spread in sub-Saharan Africa (MoOrC192-196)
  Authored by A. Buve, B. Auvert, E. Lagarde, M. Kahindo, R. Hayes, M. Carael

One session at the meeting was devoted to evaluating the role of male circumcision in transmitting or receiving HIV through heterosexual intercourse. These studies were conducted in Africa where previous studies have suggested that circumcision is protective. The upshot of several studies presented here indicated that circumcision plays a role in preventing the spread of HIV, but the actual extent of that protection was difficult to ascertain due to a number of complicating factors (confounders). These included the impact of religious affiliation and associated behavioral practices, such as post-intercourse hygiene among Muslims, who were significantly represented in some study populations. Investigators disagreed about whether circumcision should be routinely offered to men and at what age (before or after puberty). A survey in one area of Africa where circumcision is uncommon showed that many believe that circumcision is protective. Although several investigators called for a randomized trial to sort this out definitively, concern was expressed that if people had strong beliefs about the protective effect of circumcision they might be less likely to practice safe sex, which would confound any results. This session provoked a fair amount of passion on all sides, as male circumcision is seen by many in Africa as one means of decreasing the spread of HIV as part of a multifaceted approach to prevention.