WHO/UNAIDS announce recommendations about male circumcision as HIV prevention
Strategy should be employed with care
An international expert consultation convened by the World Health Organization (WHO) of Geneva, Switzerland and the UNAIDS Secretariat recommends that male circumcision be recognized as an important HIV prevention intervention in reducing the risk of heterosexually acquired HIV infection in men.
The March 28, 2007, announcement follows recent media attention over the results of randomized controlled trials conducted in Africa. Three trials demonstrate that male circumcision reduces the risk of heterosexually acquired HIV infection in men by about 60 percent. These trials also support evidence from numerous observational studies that have suggested there are lower HIV prevalence rates in African countries with higher rates of male circumcision.
WHO/UNAIDS recommend that male circumcision be part of a comprehensive HIV prevention package, including the provision of HIV testing and counseling services, treatment for sexually transmitted diseases (STDs), promotion of safer sex habits, and the promotion of correct and consistent condom use.
The challenge for the international health community, as well as for nations where circumcision might become a main prevention strategy, will be to strengthen weak health service systems and address the shortage of skilled health professionals.
WHO/UNAIDS recommend that male circumcision should be integrated into other services whenever possible.
While the studies showed that the risks of male circumcision are low, these risks could rise if the procedure is undertaken in unsanitary settings by poorly trained providers, WHO/ UNAIDS officials note.
Therefore, it should be a priority to establish training and certification of providers and provide monitoring and evaluation of programs.
Studies show that male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over a 2-decade time period.
The consulting experts found the intervention to be cost effective for governments, and they recommend that it be provided free of charge to clients.
According to the consulting experts, these are some areas that need additional study:
- What is the impact of male circumcision on sexual transmission from HIV-infected men to women?
- What is the impact of male circumcision on the health of women for reasons other than HIV transmission (i.e., could it result in lower rates of cervical cancer)?
- What are the risks and benefits of male circumcision for HIV-positive men?
- What is the protective benefit of male circumcision in the case of insertive partners engaging in homosexual or heterosexual anal intercourse?
- What sort of resources are needed to provide circumcision programs?
- What are the most effective ways to expand quality male circumcision services?
- Are there modifications in perceptions and HIV risk behavior over the long term in men who are circumcised for HIV prevention?
- Are there modifications in perceptions among communities where male circumcision is part of HIV prevention strategies?
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