Tamar Kahn: Business Day
THE Health Department's HIV/AIDS head, Dr Nomonde Xundu, has responded cautiously to this week's United Nations (UN) endorsement of male circumcision to avert HIV infection in heterosexual men. She said that promoting circumcision would have a limited effect as at least 40% of men in SA were already circumcised.
More than 5,5-million South Africans, or one in nine citizens, are infected with HIV. With no vaccine or cure in sight, many experts hope promoting male circumcision will help prevent new infections in men.
This is after three large studies showed removing foreskins cut risk of transmission 60%.
Earlier this month, the World Health Organisation and the UN joint agency on HIV/AIDS, UNAIDS, hosted an international meeting to discuss these findings. The experts announced on Wednesday that evidence of the benefits of male circumcision was "compelling", and urged African countries with low circumcision rates and high HIV burdens to offer the procedure to uncircumcised men.
Although the exact mechanism is not properly understood, male circumcision probably reduces the risk of HIV infection as it removes foreskin tissue particularly vulnerable to the virus, and because the area under the foreskin is easily scratched or torn during sex. Uncircumcised men may also be more vulnerable to sexually transmitted diseases as the region under the foreskin is a moist, dark place where germs can thrive.
Xundu said government was considering setting up a task team to investigate implementing programmes to promote circumcision as part of its HIV-prevention effort. The team would include scientists, public health experts and traditional leaders.
While the overall public health benefits might not be as great in SA as in nations hit hard by HIV/AIDS, and with low circumcision rates, she said the procedure clearly offered individual benefits.
In addition to the practical challenges of training staff to provide safe and hygienic circumcision, she expected challenges in developing communication campaigns to promote the procedure as a way of reducing the risk of HIV transmission, as it did not provide 100% protection against the virus. She said care should be taken to ensure men did not increase risky sexual behaviour if they were circumcised
Southern African HIV Clinicians' Society president Dr Francois Venter urged government to speed up development of a policy on HIV and male circumcision. He said government might consider including circumcision in new HIV-prevention programmes aimed at men, as most initiatives focused on women.
"This is a great opportunity to access a group that is difficult to reach," he said. "Women generally have more contact with public health facilities than men because they are usually responsible for their children’s health problems too."
