August 16, 2006
Researchers and HIV/AIDS advocates and experts on Tuesday at the XVI International AIDS Conference in Toronto debated whether male circumcision is a safe and effective method for preventing or reducing the spread of HIV in developing countries, the Washington Post reports. Researchers discussed a completed study from South Africa and two ongoing studies in Kenya and Uganda that examine circumcision as an HIV prevention method (Brown, Washington Post, 8/16). The South Africa study -- which was published in the November 2005 issue of PLoS Medicine and discussed last year at the IAS Conference on HIV Pathogenesis and Treatment in Brazil -- was a randomized, controlled clinical trial involving more than 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in the South African township of Soweto. Half of the men were randomly assigned to be circumcised and the other half served as a control group, remaining uncircumcised. For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. The study was halted early when researchers determined that circumcision significantly reduced HIV transmission and that it was unethical to proceed without offering the option to all males in the study (Kaiser Daily HIV/AIDS Report, 6/29). According to researchers, if adult male circumcision rates are raised by 10% each year for five years, 32,000 lives could be saved, and if the rates were raised by 20% each year for five years, 52,000 lives would be saved (Russell, San Francisco Chronicle, 8/16).
Kenya, Uganda, Other Research
The ongoing Kenyan study involves 3,000 previously uncircumcised, HIV-negative men, half of whom underwent circumcision for the study. In September 2007, researchers will count the number of men in both groups who have contracted HIV. The Ugandan study, which involves 5,000 men and is being lead by researchers at Columbia University and Johns Hopkins University, is scheduled to be completed in July 2007 (Kaiser Daily HIV/AIDS Report, 6/29). The Kenya and Uganda studies are expected to have results similar to the South Africa study, according to the Toronto Star (Talaga, Toronto Star, 8/16). Other research discussed at the conference showed that women had little or no additional protection against HIV if their sexual partners were circumcised (Washington Post, 8/16). In addition, according to University of California-San Francisco researcher James Kahn, circumcision would cost about $55 per adult male, but that cost would be offset by savings of about $2,400 in future medical costs for every averted HIV infection (San Francisco Chronicle, 8/16).
According to the Post, conference attendees discussed the cultural implications, training and other issues related to widely implementing circumcision as a way to prevent HIV (Washington Post, 8/16). Many researchers at the conference said circumcision should be widely adopted as an HIV prevention method in developing countries, Toronto's Globe and Mail reports (Nolen, Globe and Mail, 8/16). Some conference attendees complained that the research discussed did not examine cultural beliefs about circumcision, the Post reports (Washington Post, 8/16). The World Health Organization and UNAIDS have "refused to endorse" circumcision until the Kenya and Uganda studies produce successful results, the San Francisco Chronicle reports (San Francisco Chronicle, 8/16). U.N. Special Envoy for AIDS in Africa Stephen Lewis said he thinks the two agencies will alter their stance if the studies are successful. "And they will (be)," he said, adding, "We shouldn't have waited 24 hours as soon as that South African study came out" (Toronto Star, 8/16). "Our position is that the evidence to date is compelling and persuasive, but it's generally unwise to base major policy decisions on the basis of one trial," Kevin De Cock, head of WHO's AIDS office, said, adding, "I think some guidance will be issued if the other two trials are protective" (Washington Post, 8/16) "The cultural meaning of this act is much more profound than this kind of research can take account of," Gary Dowsett, an Australian sociologist, said, adding that "social scientists have been deliberately excluded from this field because they know we'll mess up the field" (Smith, Boston Globe, 8/16).
Kaisernetwork.org is serving as the official webcaster of the conference. View the guide to coverage and all webcasts, interviews and a daily video round up of conference highlights at www.kaisernetwork.org/aids2006. A webcast of the session discussing male circumcision is available online.
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2006 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.