HIV/AIDS: Why ABC remains the best approach

Editor, RE: “New learning kit to ease male circumcision” (The New Times, March 26). Male circumcision is a dangerous distraction in the fight against HIV/AIDS. 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.” This will include men who were circumcised tribally rather than medically, but they and their partners may also believe themselves to be protected, and the whole rationale for the RCT’s (randomized controlled trials) into female-to-male transmission was a purported correlation between high rates of male circumcision and low rates of HIV. 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”. This figure seems to have been unchanged in 2012. 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. ABC (abstinence, being faithful, and condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them. Europeans don’t circumcise, South Americans don’t circumcise, Australians and New Zealanders used to circumcise but stopped, and less than half of North Americans circumcise. Why should Africans circumcise? Recent news from Botswana: “There is an upsurge of cases of people who got infected with HIV following circumcision.” From Zimbabwe: “Some circumcised men are contracting HIV and Aids after ditching the use of condoms, under a misguided belief that male circumcision (MC) would prevent them from getting infected.” From Kenya: “Push for male circumcision in Nyanza fails to reduce infections.” From Uganda: “A new study of 314 female s-x workers (FSWs) in Makindye division found that more than half of respondents falsely believe that once a man is circumcised, protection is not necessary during sex.” And from Malawi: “According to the report, HIV rates have doubled in Malawi, moving from 10% to 20% in 1 year. Strangely, this has been the same period that Malawians have been forced to go through circumcision in masses with the promise that it reduces the contraction of HIV.” Lyndon *********************** Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. The investigators did not seek to determine the source of the HIV infections during their studies. They assumed all infections were heterosexually transmitted. Many HIV infections in Africa are transmitted by contaminated injections and surgical procedures. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Even if the claim were true, based on the studies, about 60 men had to be circumcised to prevent one HIV infection. Research shows that circumcision causes physical, sexual, and psychological harm, reducing the sexual pleasure of both partners. 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. Even HIV/circumcision studies advise using condoms. With condoms circumcision adds no benefit to HIV prevention. Ronald Goldman, Ph.D.

Opinions

HIV/AIDS: Why ABC remains the best approach