Commentary & Opinion
Scale-up of Male Circumcision Programs for HIV Prevention Will Require "Strong Political Backing," Funding, NEJM Perspective Piece Says
December 4, 2008
"In a radical departure from earlier strategies, public health officials are now arguing that circumcision of men should be a key weapon in the fight against" HIV in Africa, Ingrid Katz of the Beth Israel Deaconess Medical Center and Brigham and Women's Hospital and Alexi Wright of the Dana-Farber Cancer Institute write in a New England Journal of Medicine perspective piece. They add that some "skeptics argue that efforts to 'scale-up' circumcision programs on the continent that has the fewest physicians per capita may draw funds away from other necessary public health programs, ultimately threatening already tenuous health care systems."
However, all involved "agree that implementation of circumcision on a national level will require in-country champions and strong political will to succeed," according to Katz and Wright. In addition, several international donors -- including the Bill & Melinda Gates Foundation and the President's Emergency Plan for AIDS Relief -- "agree that ramped-up circumcision efforts must be funded as add-on services to guarantee that they will not detract from other programs," the authors write, adding that officials from UNAIDS and the World Health Organization "are advising that countries offer a minimum package of services in addition to circumcision, including HIV testing, screening for sexually transmitted infections, promotion of condom use and counseling on safer sex."
According to the authors, reaching out to "women through other prevention methods is important because there is no direct evidence to date that circumcision reduces the risk of transmission from men to women." They add that although "circumcision has increasing support from researchers, donors and politicians, its status as a nonbehavior-based intervention may ultimately be its biggest obstacle." As programs "move forward, the scale-up of circumcision will require strong political backing, adequate funding and leaders to champion the cause to ensure that it is a safe, low-cost option available throughout Africa," the authors conclude (Katz/Wright, NEJM, 12/4).
This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.