Male circumcision key to slowing AIDS, researcher says

Associated Press

SYDNEY, Australia — A U.S. health expert urged governments worldwide Tuesday to endorse circumcision to slow the spread of HIV, saying men without the procedure have a greater risk of contracting the virus from infected female partners.

Experts at an AIDS conference in Sydney also warned that HIV infection rates were rising among men who have sex with men in developing countries because of discrimination and lack of access to health services.

The World Health Organization says male circumcision reduces the risk of female-to-male transmission of the disease by about 60 per cent. But only 30 per cent of men worldwide have had the procedure, mostly in countries where it is common for religious or health reasons.

Robert Bailey, a professor of epidemiology at the University of Illinois, said studies in Africa showed that uncircumcised men were 2½ times more likely to contract HIV from infected female partners, although many health officials were still unclear about its benefits.

“If we had a vaccine that was 60-per-cent protective, we would be very happy and we would be rolling it out as fast as we can,” Mr. Bailey told reporters at an International AIDS Society Conference in Sydney.

“The next step is to get the leaders of countries to actually come up with policy statements endorsing the practice,” said Mr. Bailey, who has conducted circumcision-related studies in Africa and the United States.

Without local support, international agencies would be unlikely to encourage the procedure to avoid being seen as imposing foreign cultures or values, he said.

Circumcision – the removal of the foreskin from the penis – has long been suspected of reducing men's susceptibility to HIV infection because the skin cells in the foreskin are especially vulnerable to the virus.

In March, the WHO urged heterosexual men to undergo the procedure because of compelling evidence that it reduces their risk of getting the disease. It cautioned, however, that male circumcision is not a complete protection against HIV, and said men should still use condoms and take other precautions such as abstinence, delaying the start of sexual activity and reducing the number of sexual partners.

“Circumcision could drive the epidemic to a declining state toward extinction,” Mr. Bailey said. “We must make safe, affordable, voluntary circumcision available now.”

He also called on international agencies to ramp up funding for circumcision in countries hardest-hit by the epidemic.

Michel Kazatchkine, the executive director of the Global fund, a leading international health agency, also called for increased funding.

“I believe that the evidence is overwhelming for the efficacy of circumcision,” Mr. Kazatchkine told the Associated Press on the sidelines of the meeting. “And if countries come to us ... I see no reason at all why we wouldn't fund that.”

Mr. Kazatchkine said his organization had not received any requests for funding for circumcision, since the WHO advice on the topic was only released in March.

Also at the conference, a leading American AIDS research group said HIV infection rates among men who have sex with men were rising in Africa, Asia and Latin America, citing figures from UNAIDS.

Studies also show that fewer than 5 per cent of that group have access to HIV-related health care, the American Foundation for AIDS Research (amfAR) said.

“This is a massive failure of the HIV/AIDS response globally and I think one that needs to be addressed,” said Kevin Frost, amFAR's chief executive officer.

In Kenya, about 40 per cent of homosexual men are estimated to be HIV positive, compared with a 6-per-cent rate in the country's overall population, amFAR said. In Senegal, nearly 22 per cent are believed to be infected, compared with fewer than 1 per cent of the general population.

In Uruguay and Mexico, 21 per cent and 15 per cent are estimated to have the disease.

Under an initiative launched at the AIDS Society Conference, amFAR will seek to raise $3-million over the next three years to provide grants for AIDS education and research among men who have homosexual sex in developing countries.