With people dying of Aids in far greater numbers than those who have access to treatment and prevention, male circumcision could be a promising tool in the prevention of transmitting HIV, scientists told the International Aids Conference in Toronto, Canada, on Thursday.
Others cautioned that the procedure could give men a false sense of security and may not protect women from contracting the disease.
Former United States president Bill Clinton said earlier in the week that while two clinical trials under way in Africa were promising, it would be a ”headache” to implement, due to the medical and religious debates surrounding the surgical removal of the foreskin from the penis.
In June, the US National Institutes of Health announced that, following an interim review, two ongoing trials in Uganda and Kenya should continue examining the link between male circumcision and the risk of getting the virus that 40-million people are living with today.
The virulent virus — for which scientists have yet to develop a vaccine — has killed an estimated 25-million people since the first cases of HIV were reported 25 years ago.
Between 2003 and 2005, the number of people in low- and middle-income countries on anti-retroviral drugs increased by 450 000 each year. Yet over the same period, the number of people who became infected with HIV averaged more than four million a year.
Data from the trials, scheduled to conclude next year, could validate findings reported in July 2005 from a South African trial, known as the Orange Farm intervention trial, which showed a reduction of 60% in the risk of acquiring HIV among circumcised men.
”The results of the two ongoing trials will help clarify the relationship between male circumcision and risk of HIV in differing contexts, which is key to determining the reproducibility and application of the Orange Farm findings,” said Dr Kevin de Cock, head of the World Health Organisation’s HIV/Aids programme.
Clinton, whose foundation is heavily involved in Aids programmes, told reporters that while current studies indicate circumcision may be effective, it could lead to a whole new set of personal debate and medical problems.
”I think for men the most promise is in the circumcision studies,” Clinton said earlier in the week when asked about the current buzz over promising HIV-prevention tools, such as microbicides for women. ”But it’s going to be a total headache trying to help them.”
Catherine Hankins, chief scientific adviser for the United Nations Joint Programme on HIV/Aids, said researchers are excited about the potential use of circumcision as a tool to fight HIV, but cautioned that it could give men a false sense of security and may not protect women from contracting the infection.
”Even if further trials show a lower risk of HIV infection in circumcised men, male circumcision will not provide complete protection against HIV infection,” she said. ”Circumcised men can still contract HIV and pass it to their partners. If male circumcision is proven to be effective, it must be considered as just one element of a comprehensive HIV-prevention package.”
In Africa, about 70% of men are circumcised at birth or in tribal ceremonies. The soaring HIV infection rates in sub-Saharan Africa are found in communities that do not practice circumcision, such as Swaziland, which has the world’s highest HIV infection rate of 33%.
Studies show that HIV infection rates drop dramatically in West Africa and other parts of the continent where circumcision is routinely performed.
Hankins said that tests have shown that the male foreskin is rich in blood cells that are favoured targets of HIV. — Sapa-AP