|
Circumcision Could Prevent Millions of HIV
Infections
WESTPORT, Nov 23
(Reuters Health) - Because uncircumcised men have an increased risk of HIV
infection, this procedure should be added to the armamentarium of AIDS
prevention, according to an article in the "Viewpoint" section of the
November 20th issue of The Lancet.
The authors
believe that the evidence linking male circumcision with regional discrepancies
in the rates of HIV infection is now "compelling." Ten years ago,
Cameron et al. reported that uncircumcised men have greater than 8-times the
risk of HIV-infection, Drs. Daniel T. Halperin of the University of California
in San Francisco and Robert C. Bailey of the University of Illinois at Chicago
point out. Since then, the results of other studies have confirmed this
association.
"However, the
association between lack of male circumcision and HIV transmission has met with
fierce resistance, cautious skepticism, or, more typically, utter
silence," they write. Health professionals may be reluctant to make male
circumcision a part of their HIV/AIDS prevention strategy because of "...deeply
held cultural values and religious beliefs."
"By avoiding
this issue altogether, medical professionals and public health authorities may
inadvertently be harming the very individuals whom they are trying to
help."
Drs. Halperin and
Bailey believe that it is time to take several courses of action. Communities
should be provided with information that allows for informed decisions about
circumcision. Training and resources also need to be provided to make
circumcision safe.
It is also time,
according to the authors, to investigate the feasibility of introducing male
circumcision to communities with a high HIV seroprevalence that do not
traditionally participate in this practice.
The authors
caution that it must be made clear that while circumcision can reduce the risk,
it does not provide full protection against HIV infection. In addition,
findings from one study cited by the clinicians suggested that circumcision
performed after the age of 20 years did not reduce the risk of HIV
transmission.
"Circumcision
could have a huge impact on the HIV pandemic in many developing
countries," Dr. Baily commented in a University of California San
Francisco press release. "The number of infections probably caused by lack
of male circumcision already reaches into the millions," Dr. Halperin
added. "We would expect the international health community to at least
consider some form of action, but male circumcision remains largely unexplored
as a tool against AIDS."
Lancet 1999;354:1813-1815.
|