Circumcision not enough to stop HIV, experts warn experts

As thousands of young men in Nyanza Province troop to health centres to be circumcised in hopes of fending off HIV, new studies show it might be too early to claim victory. Although circumcision has been touted as one of the ways to prevent HIV infection, recent findings show an increase in HIV infection in regions where most males are circumcised.

According to findings of the Kenya Aids Indicator Survey (Kais) released last week, North Eastern and Coast provinces, where 97 per cent of males are circumcised, registered an increase in HIV prevalence.

Within a span of five years, HIV prevalence in North Eastern and Coast provinces increased from 0 to 1.0 per cent and from 5.8 per cent to 8.3 per cent respectively. In the same period, HIV prevalence in Nyanza Province, where about 48 per cent of males are circumcised, stood at 15 per cent, the highest in the country.

These are sobering statistics for young men who have rushed to get circumcised in he belief that doing so would provide complete protection from HIV infection. The new findings of growing HIV prevalence among circumcised males indicates the practice cannot completely protect an individual from HIV infection unless it is combined with other practices including using condoms, being faithful to one partner, or abstaining from sex.

Health officials acknowledge that getting people to look at circumcision in the larger context of other factors and strategies can be challenging. “The figures from these two provinces are sending a warning that circumcision alone is not the magic bullet to controlling the disease. Other methods have to be used in combination,” said Dr Ibrahim Mohammed, Head of National Aids and STD Control Programmes in the Ministry of Medical Services.

The increase in prevalence in communities that circumcise indicates there are other factors that contribute to the spread of the disease among males in addition to being uncircumcised. Multiple sexual partners, low condom use and alcohol and drug abuse are some of the factors.

“Unless we address all the reasons predisposing people to HIV infection, we might not make much headway,” said Judy Adero, who has lived with the virus for nine years. But scientists still believe circumcision will result in the lowering of HIV prevalence in provinces such as Nyanza.

Dr David DeCock, director of the Kenya office of the US Centers for Disease Control, said there is no doubt that circumcision prevents HIV infection. The Kais study shows HIV prevalence among circumcised men aged between 20 and 64 years was approximately three to seven times lower than among uncircumcised men in the same age range.

The study further shows that the rate of HIV prevalence among circumcised men was 3.9 per cent compared to 13.2 per cent among the uncircumcised men. Buoyed by these significant differences, the government and other organisations have opened 200 circumcision centres.

More than 30,000 men have been circumcised since the call first went out; the target of 100,000 circumcised men is expected to be reached by year’s end.

Meanwhile, female activists have criticised the way the whole operation is being carried out, arguing that it is making women more vulnerable as men engage in sex with multiple partners secure in the knowledge that they are safe.

The decision to adopt circumcision as one method in the HIV prevention strategy has been informed by research findings of three main studies done in South Africa, Uganda and Kenya which showed circumcision to reduce the risk of HIV infection by up to 60 per cent.

This was followed by World Health Organisation and UNAids issuing strong recommendations for increased male circumcision rates in countries where the HIV prevalence is high. Two years ago, Kim Dickson, coordinator of the joint WHO/UNAids working group that came up with the recommendations told the journal New Scientists: “We reviewed all the evidence, and the evidence is compelling.”

In the South Africa study, circumcision was found to reduce HIV infection rates by more than 60 per cent in a group of 3,000 HIV-negative men. Of the 1,546 men who were circumcised, 20 became infected with HIV while 49 of the 1,582 uncircumcised men became infected.

The findings made the South African scientists undertake large-scale male circumcision as a possible strategy for preventing two million HIV infections and 300,000 deaths in their country over the next 10 years. In December 2006, the Data Safety Monitoring Board that was overseeing the Kenyan and Ugandan male circumcision trials announced the operation was a safe and effective way to reduce HIV infection among men.