Big boost for the snip
CAPE TOWN – The US government will give South Africa R100-million to expand its medical male circumcision programme, US Global AIDS Co-ordinator, Ambassodor Eric Goosby announced yesterday.
This will be in addition to the R360-million the US President’s Emergency Plan for AIDS Relief (Pepfar) has already committed to South Africa this year, said Goosby.
“We have shifted our focus to high-impact HIV prevention interventions, and top of the list is medical male circumcision,” Goosby announced, after touring the Woodstock Community Centre.
The attraction of MMC for donors is that one medical procedure to remove a man’s foreskin can reduce a man’s risk of getting HIV by 60 percent, explained Dr Thobile Mbengashe, Chief Director of HIV/AIDS in the health department.
“If we could develop an AIDS vaccine that was 60% successful, we would be very happy,” said Mbengashe.
To date over 170 000 MMCs have been done through the health department’s programme, with this year’s target set at 500 000.
More than a million new HIV infections could be prevented if 80 percent of men aged 15 to 49 were circumcised, according to the health department. This would save over R55-billion in treatment costs.
“South Africa’s AIDS programme is at a tipping point where it is about to register a drop in the number of new infections (in comparison to people being put on ARV treatment),” said Goosby. “Once this happens, there is usually a steep drop and it is important not to take your foot off the accelerator.”
The SA Clothing and Textile Workers Union (Sactwu)’s Worker Health Program is a key partner helping the government to provide MMC countrywide, and so far has overseen 80 000 circumcisions since July 2011.
The programme’s executive director, Nikki Soboil, said the success of Sactwu’s programme was “going to the people rather than expecting them to come to us”.
Initially a work-based programme, Sactwu had set up “roving MMC teams”, said Soboil.
Staff members were able to circumcise 200 to 250 people a day in places such as community halls as long as there was access to water and electricity.
“We have managed to reduce the costs of male medical circumcision to $80 (R800) per procedure,” said Soboil.
“The creativity of the roving teams is incredible. Reaching people where they are is the answer,” said Dr Nono Simelela, special adviser to Deputy President Kgalema Motlanthe.
The TB/HIV Care Association is also helping to roll out MMC in prisons as well as in seven health districts.
TB/HIV Care recently met 60 traditional leaders in the Eastern Cape in an attempt to integrate medical male circumcision with traditional initiation ceremonies.
“They thought we were also doing initiation but we explained that we are just doing the procedure,” said TB/HIV Care’s Zolani Barnes.
“We are proposing that we do the procedure and after the healing process, the men go for initiation. Some have agreed but there is some resistance.”
“An AIDS-free generation is possible with collaboration and focussed political leadership,” said Simelela. – Health-e News Service.
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From a USAID report:
“There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
It seems highly unrealistic to expect that there will be no risk compensation. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.
http://www.info.gov.za/issues/hiv/survey_2009.htm
It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.
Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. They have various flaws. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Authorities that cite the studies have other agendas including political and financial. Research shows that circumcision causes physical, sexual, and psychological harm. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Please see http://www.circumcision.org/hiv.htm for more information and links to literature.
Goosby’s logic is terrible. Circumcision is no vaccine of any kind. The mostly-cut US has three times the HIV incidence that mostly-intact Europe has.
In 2009 researchers Wawer/Gray reported to the WHO that the Ugandan men they circumcised infected their female partners 50% MORE often with deadly HIV than the men they left intact did. Until this finding is understood mass circumcision campaigns are incredibly irresponsible.