 |
|
|
| |
Circumcision touted as HIV defense
|
| |
| |
By Stephen Smith, Boston Globe Staff
August 16, 2006
TORONTO -- Tens of thousands of HIV infections could be avoided in a single South African township with even a small increase in circumcision among adult men, according to a study made public yesterday. At just $55 per procedure, circumcision would potentially save millions of dollars in AIDS treatment expenses, another study found.
Struggling to find novel ways of slowing the spread of HIV, scientists have increasingly focused their attention on the circumcision of adult men, a relatively risk-free procedure that removes the foreskin, where cells are particularly susceptible to the AIDS virus. One lab study showed that foreskin is nine times more likely to be infected by HIV than cervical tissue. But as these findings were being presented yesterday at the 16th International AIDS Conference, social scientists here complained that social and ethical considerations were being given short shrift.
``The cultural meaning of this act is much more profound than this kind of research can take account of," said Gary Dowsett, an Australian sociologist.
In an interview, Dowsett charged that ``social scientists have been deliberately excluded from this field because they know we'll mess up the field."
But Robert C. Bailey, a researcher engaged in an ongoing circumcision study in Kenya, disputed Dowsett's assessment.
Bailey, of the University of Illinois at Chicago, said his research team included social scientists who conducted extensive interviews with Kenyans to gauge their beliefs about circumcision before embarking on the medical trial. Bailey's study is one of two continuing in Africa -- the other is in Uganda -- with the potential to change global health policy.
The World Health Organization said the studies in Kenya and Uganda, in which half of the men are given circumcisions and half are not, would prove pivotal in helping to determine whether male circumcision should be promoted as a prevention method.
The skin of circumcised men is thicker and less prone to penetration by the virus, research has found. In some parts of Africa, circumcision rates are comparable to those in the United States -- at least 70 percent of the men -- while on other parts of the continent, rates are much lower. AIDS specialists have long noticed that infection rates are highest in areas of Africa where circumcision rates are lowest.
But scientists concede that circumcision is not a panacea. They fear that if men are circumcised, they might, for example, think they can for go condoms.
``When we think about circumcision, we're not talking about it as a stand-alone prevention strategy," said Kawango Agot, a Kenyan researcher.
Attitudes could blunt circumcision as weapon
Study results on slowing AIDS awaited
If proven valuable, social hurdles loom
Aug. 16, 2006. 01:28 AM
http://www.thestar.com
Circumcision may slow the rate of HIV infections, but cultural taboos and lack of medical staff could stand in the way of an ambitious African program.
It has to be rolled out in a culturally sensitive way and that will vary from country to country, said Stephen Lewis, the United Nations Special Envoy on HIV/AIDS. "Some of it will be slow and some rapid," he said. "But, if it is going to save a lot of lives, we have to do it."
Former U.S. president Bill Clinton addressed the issue at yesterday's International AIDS Conference in Toronto, saying as soon as more evidence-based science shows it prevents HIV, the world has to support it.
"Should it be shown to be effective, we'll have another means to save lives, we'll have another big job," he said in a keynote address. The first hurdle will be to convince men to undergo the operation where it has not been the custom. The second challenge will be to provide adequate medical care in places where there are no hospitals, doctors or nurses.
Last year a study of 3,274 men in Orange Farm, South Africa, was halted for ethical reasons just 18 months after it began because 60 to 75 per cent of circumcised men appeared to be protected from HIV, and the investigators wanted to offer the operation to the uncircumcised control group.
Now the world eagerly awaits word on two big studies, one in Uganda and the other in Kenya, which are expected to show similar results by their conclusion in 2007.
Lewis believes the World Health Organization and UNAIDS will appoint to decide how to roll out a widespread circumcision program it if the other two studies are successful.
"And they will (be)," he said. "We shouldn't have waited 24 hours as soon as that South African study came out."
In Swaziland, men are lining up to be circumcised, and Lewis said it's almost become fashionable.
"Why? I suspect it's because Swaziland has one of the highest infection rates in the world," Lewis said.
Not only does circumcision seem to significantly decrease the likelihood of infection in men, it also seems to reduce the risk of HIV infection in women.
`But, if it is going to save a lot of lives, we have to do it'
Stephen Lewis, United Nations Special Envoy on HIV/AIDS
"As people understand this is positive and works both ways, and if we can get solid protocols for the surgery - antiseptic, clean, fast and easy, all of which most surgeons suggest is possible - gradually there'll be an uptake," he said.
But health officials caution circumcision may reduce the risk of HIV infection, but it doesn't provide full protection.
They worry the safe-sex message may get lost in the rush to circumcise.
A recent review of HIV statistics by the non-profit Public Library of Science estimated some 2 million new infections and around 300,000 deaths could be avoided in South Africa alone if all men were circumcised.
Last summer, outside experts looked at the Kenyan and Ugandan trials and decided they did not have to be halted for ethical reasons, but the Kenyan trial may be reviewed again in the next six months, said the University of Illinois's Dr. Robert Bailey, co-leader of the study along with the University of Manitoba's Dr. Stephen Moses.
Both the Ugandan and Kenyan trials are funded in part by the U.S. National Institutes of Health.
The Uganda trial involves 5,000 participants age 15 to 49 while the Kenya study involves 2,784 men aged 18 to 24.
Moses said if circumcision is widely adopted shortly after his study results, there has to be a lot of preparation, training and figuring out how to deliver.
"It's not going to happen overnight," he said.
Dr. Kevin De Cock, director of the HIV/AIDS department at the World Health Organization, said they will wait until the two trials are complete before deciding whether to add it to their list of recommended measures to safeguard against HIV.
It won't be an easy intervention, he acknowledged. "People are more reticent," he said. "It requires a higher standard of proof than we might need for a more innocuous intervention such as a drug."
Removing the foreskin is a minor operation that takes about 30 minutes, but it is traumatic for an adolescent or adult and there is a risk of complications such as bleeding and infection.
|
| |
|
|
|
|
|
