Scientists at the International AIDS Conference in Toronto have been calling for urgent action on compelling evidence that circumcision may reduce a man's vulnerability to HIV infection by as much as 60 percent.
Prevention technologies such as vaccines and microbicides are still years away from reaching people at high risk of infection, while male circumcision is available now and could save lives without breaking the bank.
Several African countries have already acted on the results of a South African-based study released last year, which appeared to confirm that circumcision has a protective effect against HIV transmission.
Zambia and Swaziland have both launched national male circumcision programmes, while a new report by the 14-member Southern African Development Community described male circumcision as "a one-off intervention conferring lifelong reduced biological risk". Other countries, including South Africa, are delaying action until the results of further trials underway in Kenya and Uganda become available.
Dr Robert Bailey of the University of Illinois presented an overview of the two-year Kenyan trial at the conference on Tuesday, but said results would not be available until September 2007. He did reveal that, one year into the study, the 50 percent of participants who had been circumcised reported using condoms more consistently and paying for sex less frequently.
This is a key finding, in light of one of the biggest concerns surrounding male circumcision: that men might view it as an alternative to condoms and safer sexual behaviour rather than as an additional protection against HIV.
Another study from Kenya, supported by the National Institutes of Health and presented by Dr Kawango Agot, also found no significant difference in condom use or risky sexual behaviour between samples of circumcised and uncircumcised men.
Dr Kyeen Mesesan, of Yale University, used a mathematical simulation to estimate what impact male circumcision programmes of various sizes could have on the course of the epidemic in the South African township of Soweto. Based on a population of 823,000 sexually active men and women, she found that a programme targeting just 10 percent of men could result in 32,000 infections averted, and a drop in prevalence from 17 percent to 14 percent over 20 years.
Without circumcision, her model predicted that prevalence would increase to 23 percent over the same period. "For South Africa and countries with similar epidemic profiles," she concluded, "even modest programmes offering male circumcision would confer enormous benefits in terms of HIV infections averted and should be introduced immediately".
The cost-effectiveness of such programmes as a prevention method in sub-Saharan Africa was the subject of a presentation by Dr James Kahn of the University of San Francisco. Taking into account the costs of treating HIV-infected individuals over a lifetime, Kahn found that adult male circumcision could actually save money.
Although presenters appeared to agree on the potential benefits of male circumcision, they did not touch on the logistical, social and cultural barriers to implementing national programmes.
Circumcision is often an important rite of passage for boys into manhood, while other ethnic groups, even though they are hard-hit by the pandemic, regard it as "untraditional". In the Southern African kingdom of Swaziland, where the estimated HIV prevalence is over 40 percent, traditionalists have frowned upon circumcision as a custom of the AmaXhosa, an ethnic group in neighbouring South Africa.
World Health Organisation (WHO) researchers and colleagues, while supporting the procedure as a prevention tool, reported that male circumcision could prevent millions of new HIV infections but warned against risky sexual behaviour.
The organisation recently cautioned that circumcision showed promise in reducing the risk of aquiring HIV, but this did not mean circumcision alone could prevent men from becoming infected with HIV during sexual intercourse. "It will therefore be essential that it [circumcision] be implemented as part of a comprehensive prevention package, which includes correct and consistent condom use, behaviour change, and voluntary counselling and testing."
Prevention technologies such as vaccines and microbicides are still years away from reaching people at high risk of infection, while male circumcision is available now and could save lives without breaking the bank.
Several African countries have already acted on the results of a South African-based study released last year, which appeared to confirm that circumcision has a protective effect against HIV transmission.
Zambia and Swaziland have both launched national male circumcision programmes, while a new report by the 14-member Southern African Development Community described male circumcision as "a one-off intervention conferring lifelong reduced biological risk". Other countries, including South Africa, are delaying action until the results of further trials underway in Kenya and Uganda become available.
Dr Robert Bailey of the University of Illinois presented an overview of the two-year Kenyan trial at the conference on Tuesday, but said results would not be available until September 2007. He did reveal that, one year into the study, the 50 percent of participants who had been circumcised reported using condoms more consistently and paying for sex less frequently.
This is a key finding, in light of one of the biggest concerns surrounding male circumcision: that men might view it as an alternative to condoms and safer sexual behaviour rather than as an additional protection against HIV.
Another study from Kenya, supported by the National Institutes of Health and presented by Dr Kawango Agot, also found no significant difference in condom use or risky sexual behaviour between samples of circumcised and uncircumcised men.
Dr Kyeen Mesesan, of Yale University, used a mathematical simulation to estimate what impact male circumcision programmes of various sizes could have on the course of the epidemic in the South African township of Soweto. Based on a population of 823,000 sexually active men and women, she found that a programme targeting just 10 percent of men could result in 32,000 infections averted, and a drop in prevalence from 17 percent to 14 percent over 20 years.
Without circumcision, her model predicted that prevalence would increase to 23 percent over the same period. "For South Africa and countries with similar epidemic profiles," she concluded, "even modest programmes offering male circumcision would confer enormous benefits in terms of HIV infections averted and should be introduced immediately".
The cost-effectiveness of such programmes as a prevention method in sub-Saharan Africa was the subject of a presentation by Dr James Kahn of the University of San Francisco. Taking into account the costs of treating HIV-infected individuals over a lifetime, Kahn found that adult male circumcision could actually save money.
Although presenters appeared to agree on the potential benefits of male circumcision, they did not touch on the logistical, social and cultural barriers to implementing national programmes.
Circumcision is often an important rite of passage for boys into manhood, while other ethnic groups, even though they are hard-hit by the pandemic, regard it as "untraditional". In the Southern African kingdom of Swaziland, where the estimated HIV prevalence is over 40 percent, traditionalists have frowned upon circumcision as a custom of the AmaXhosa, an ethnic group in neighbouring South Africa.
World Health Organisation (WHO) researchers and colleagues, while supporting the procedure as a prevention tool, reported that male circumcision could prevent millions of new HIV infections but warned against risky sexual behaviour.
The organisation recently cautioned that circumcision showed promise in reducing the risk of aquiring HIV, but this did not mean circumcision alone could prevent men from becoming infected with HIV during sexual intercourse. "It will therefore be essential that it [circumcision] be implemented as part of a comprehensive prevention package, which includes correct and consistent condom use, behaviour change, and voluntary counselling and testing."
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