Failure to Circumcise Men "May Have Cost Millions of AIDS Deaths"

Years of failing to translate into practice the results of research showing the protective effects of male circumcision may have cost "millions of lives," especially in Africa, say AIDS experts. Properly performed, the procedure can reduce the risk of female-to-male HIV transmission by up to 60 percent, studies have shown.

In 1985, researchers found that circumcised male clients of sex workers were much less likely to contract HIV. About 30 studies on male circumcision and HIV were conducted during the 1990s. However, it was not until 2004 that double-blind studies were commissioned by international AIDS agencies, finally showing "overwhelming results." Last year, pilot mass circumcision programs began in many African countries.

"There's a good question to be asked of the research agencies: Why they did not start the trials earlier," said Dr. Catherine Hankins, the chief science advisor to UNAIDS. "We had 20 years of observational data on circumcision. I can't think of another product, or technique, that waited so long before trials."

"If you had a trial that showed a vaccine had a 75 percent success rate, you wouldn't hesitate to get it into production," said Daniel Halperin, a Harvard Medical School public health professor and former US government HIV prevention advisor.

"Epidemiologists come across some evidence, and then decide the public is too stupid to be trusted with it," said Elizabeth Pisani, a former UNAIDS epidemiologist. "Essentially it was thought that if people knew that circumcision made sex safer, they would not bother to use condoms. We didn't want to distract them."

"There's been a failure of global health institutions," said Professor Francis Plummer, who led the Nairobi research team that studied the male sex-worker clients in the 1980s. "It's a frustration I've lived with for a very long time."

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