HIV transmission and circumcision

[Guest fountainhall]

There's a long article in today's Britush Sunday paper, The Observer. The headline reads -

 

So, would you have your son circumcised?

The idea may horrify you. But what if you knew it could potentially save his life?

 

Here are some snippets.

 

 

1. Quite simply, circumcised men are around 60% less likely to contract HIV and other sexually transmitted diseases. And of course, they are less likely to pass them on - and that has a huge effect on STD rates in women. Studies suggest that women whose long-term partners are circumcised are two to three times less likely to develop cervical cancer.

 

2. People of the Luo tribe have an HIV rate up to three times as high as the circumcised tribes of Kenya. Although not circumcising has long been a matter of pride and distinction to them, an education campaign has persuaded the elders to sanction the mass circumcision.

 

3. Francis Otieno, a counsellor and mobiliser with the Nyanza Reproductive Health Society, says: "Abstinence, circumcision and a condom. They're all good ideas. But with the circumcision programme we think we can reduce the new HIV infection rate here to half what it was in two years." No other HIV-Aids intervention, in the 25-year history of fighting the disease in the rich world and the poor, has achieved anything remotely near that.

 

4. Elizabeth Pisani, who during the 1990s worked as an epidemiologist in Asia for UNAids, the joint United Nations programme for tackling the epidemic, said that from early in that decade her colleagues were well aware then that there were inexplicable discrepancies in Aids rates in countries where circumcision was common, and where it wasn't - between Indonesia and the Philippines, for example, and Thailand and Cambodia. Sexual habits were similar in all four countries - but the first two circumcise while the northern ones don't. And the worst heterosexual HIV infection rates, at least 10 times as high, were in Thailand and Cambodia.

 

5. Even the conservative Atlanta Center for Disease Control has now published its assessment - and after years of denial, it is now guardedly pro-circumcision, in Aids-prone countries at least. CDC's current briefing paper assesses the accumulated studies and sums up: "The relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at sexually transmitted disease clinics, for whom the adjusted relative risk was 71% lower for circumcised men."

 

 

So, the debate continues. Is it likely to result in greater popularity for circumcision in Thailand. I doubt it.