Male Circumcision

• Pages: 38-41

Contenidos

• The Issue.
• Legal and Policy Considerations.
• Practice Examples.
• References.

Page 38

The Issue

Male circumcision has been carried out for religious and cultural reasons for thousands of years. Observational studies had noted significantly lower rates of HIV infection in countries and regions where the practice of male circumcision is widespread. In 2005 and 2006 three randomized controlled trials evaluated the impact of male circumcision on the risk of HIV infection in males. All three trials confirmed that male circumcision, performed by well trained medical professionals, is safe and reduced the risk of HIV infection by between 50 and 60%. Some experts estimate that if male circumcision is widely and properly carried out it could have a major impact on HIV prevalence and prevent tens of thousands of new HIV infections. It is likely that there will be a growing demand for safe, affordable male circumcision, particularly in high HIV prevalence areas. Already a number of governments in sub-Saharan Africa, led by Swaziland and Kenya, have reacted positively to the research findings, making it probable that they will introduce policies, regulations, and laws that promote and provide male circumcision.

Legal and Policy Considerations

In March 2007, information from the trials led to the WHO and UNAIDS issuing a first set of guidelines on male circumcision as an HIV prevention intervention. Whilst finding "that the efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt," the guidelines are correctly cautious. They stress that male circumcision is not completely efficacious; that there is no evidence yet that it reduces the risk of an HIV infected man infecting a female partner; and that the risk of the creation of a false sense of security needs to be actively countered in HIV prevention and public health messaging.

Male circumcision should never replace other known methods of HIV prevention and should always be considered as part of a comprehensive HIV prevention package, which includes: promoting delay in the onset of sexual relations, abstinence from penetrative sex and reduction in the number of sexual partners; providing and promoting correct and consistent use of male and female condoms; providing HIV testing and counselling services; and providing services for the treatment of sexually transmitted infections.

Page 39

WHO and UNAIDS advise that

...