alexa Separate culture from health benefit - Daily Nation

Separate culture from health benefit

Sunday September 7 2008

The recent article in the Nation by Dr Otieno Mbare titled: These Calls for Circumcision are Terribly Misleading, represents serious distortions about recent studies on male circumcision (MC) that were done in Kenya, Uganda and South Africa.

As researchers who coordinated the Kisumu study, we feel obliged to correct the distortions. First, the results of the Uganda and Kenya trials were published in the Lancet of February 2007 (Lancet 2007; 369:643-656) and not in the BJU International as the author reported.

An article that was published in the BJU, which by the way appeared in 2005 and not January 2008, addressed the excellent safety record of the MCs performed at our clinic and not the impact of MC on HIV acquisition (British Journal of Urology International, 2005 Nov; 96(7):1109-13).

We recommend that the author reads the right publications, because his position appears to have been informed by a wrong document.

Regarding sexual performance, we found no differences in the reports by men before and after circumcision, and there were no differences between circumcised and uncircumcised men.

This discussion is soon to be published in Journal of Sexual Medicine.

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The suggestion that the studies were lopsided research whose methodology, validity, plausibility and veracity are in doubt… and that… the research is so hollow; there is no knowing whether the sample group had been subjected to full blown situation to validate the finding, is a clear indication that the author is not at all conversant with epidemiological research designs and conduct.

For his information, a randomised-controlled trial (RCT) design is the gold standard of health research design upon which important health policy decisions are made.

If our study showing that male circumcision reduces HIV incidence by 60 per cent were faulty, the results would never have been accepted in the Lancet, the world’s top international medical journal.

Furthermore, the World Health Organisation and other world bodies would not have reviewed the evidence and declared that “The efficacy of male circumcision in reducing female to male HIV transmission has now been proven beyond reasonable doubt.

This is an important landmark in the history of HIV prevention.” (WHO/UNAIDS, March 28, 2007).

And, Kenya’s Ministry of Health would not have endorsed the male cut as one of the strategies to reduce the spread of HIV in the country (Policy on Male Circumcision in Kenya, January 2008).

Pertinent questions at this point should be how to provide safe and voluntary male circumcision for HIV prevention; how to educate people that it’s only partially protective; how men and women must continue to use other known HIV prevention strategies, including correct and consistent condom use, prompt and complete treatment of STIs, and reduction in number of sexual partners; and how men can involve their female partners in decisions around MC.

These questions will affect circumcising and non-circumcising communities alike.

For example, communities that circumcise their males at puberty may begin to think about circumcising at infancy or childhood; those who go to the river may consider taking their sons to the health facilities; and those who circumcise during specific seasons may start seeking the services at any time.

We do NOT recommend that people begin to consider male circumcision for cultural reasons.

Our role as researchers is to provide that accurate information to guide individuals in making decisions that affect their lives and the lives of those they value.

Mr Agot is a former coordinator of the Kisumu MC study; Mr Onyango is the current coordinator.

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