The trial showed promising protective effects of adult male circumcision in reducing HIV infection, although UNAIDS emphasized that more research was needed to confirm the findings. During that time, there were also two ongoing trials in Uganda and Kenya, funded by the US National Institutes of Health, whose results were also expected to clarify the relationship between male circumcision and HIV in differing social and cultural contexts.

Key Issues:

• The XVI International AIDS Conference is about to commence in Toronto, Canada. The study released in Jul 2005 by the World Health Organization should ensure that the topic finds its way into the main agenda. What were the key perspectives drawn out by the WHO’s study?
• According to the Kaiser Network’s Daily Report on October 26, 2005, more than 3000 young men were involved in the trial carried out in South Africa. It was found that male circumcision reduces the risk of HIV transmission by 65%. The researchers continually tested the men for HIV infection over 21 months (Sample, Guardian, 10/25). During the trial, they recorded 20 HIV infections among the circumcised men and 49 infections among the uncircumcised men the risk of contracting the virus during intercourse with an infected woman by about 65 percent. What implications do these findings have in the prevention strategies employed to combat HIV?
• Some scholars say that the studies were largely observational and therefore ‘no causal relationship between male circumcision and HIV prevention could be confidently assumed’. (Siegfried N (2005) Does Male Circumcision Prevent HIV Infection? PLoS Med 2(11): e393). Can governments be encouraged to support of fund nationwide awareness programmes on male circumcision based on these findings? Are there other current studies to lend weight to the conclusions drawn by the initial trials? E.g.
  i.In a study of male partners of HIV positive women in Rakai, Uganda, 40/137 uncircumcised men versus 0/50 circumcised men became infected.
• If male circumcision proves effective,
  what would be the social or cultural barriers to its full implementation as a prevention strategy? What issues would policy makers and policy influencers have to take into consideration before creating or advocating for male circumcision as a potential; prevention method?
• Circumcision has been referred to often as a harmful health practice. The uses of unsterilised blades, penile mutilation or death during the circumcision rite are examples of the concerns surrounding male circumcision. Journalists should identify the advantages and potential risks involved in the practice.

For more information:
http://www.who.int/mediacentre/news/releases/2005/pr32/en/
http://www.eldis.org/cf/search/disp/DocDisplay.cfm?Doc=DOC22333&Resource=f1hiv
http://www.kaisernetwork.org/Daily_reports/rep_index.cfm?DR_ID=33323

Contact:
Mrs M. L. Rurangirwa - Division of Communicable Disease Prevention and Control
World Health Organisation
regafro@afro.who.int

Nandi Siegfried : South African medical expert who has written reviews on observational studies on Male Circumcision
nsiegfried@cochrane.co.uk