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Circumcision 'no silver bullet'
19/05/2007 07:28 - (SA)
Cape Town - Male circumcision should not be seen as a "silver bullet" in fighting HIV infection, University of Cape Town researchers said in a paper published in the latest issue of the SA Medical Journal.
The evidence for the preventive benefit of male circumcision was "rather modest", and did not warrant "heroic policies or practises", humanities student Alex Myers and co-author, public health professor Jonny Myers, said.
"The current zeal and naive enthusiasm for promoting circumcision as an Aids prevention tool show lack of regard for the limited degree of benefit likely," they said.
Potential harm included the possibility that newly-circumcised men would feel less inhibited about having risky sex.
There was also the threat of surgical complications "and worse" from the operation itself, and increased costs and strain on thinly stretched health services.
Recent research had shown that HIV infection was about three times more likely as a result of the circumcision procedure itself in three African settings - Kenya, Lesotho and Tanzania.
One should also not lose sight of the ethical issues of circumcising non-consenting infants.
Circumcision 'politically acceptable'
The authors said that in the Eastern Cape, where most men were circumcised, the HIV prevalence rate was not meaningfully lower than in KwaZulu-Natal, where most were not.
They also said it was useful in weighing up circumcision to ask how consistent attitudes were on preventive surgery.
A Tanzanian study had found that female circumcision reduced HIV transmission. Biologically, the explanation for this was probably the same as for male circumcision.
If female circumcision was medicalised in a similar way to male circumcision, it could be made safer and less damaging.
They said: "The downplaying of these facts in the media is a powerful reflection of Western cultural attitudes.
"We have already decided that female circumcision is an appalling human rights violation and so do not even flirt with the idea of using it as an HIV prevention tool.
"Similar arguments apply to mastectomy in teenage girls, even though this would be effective to prevent breast cancer in later life.
"The difference with male circumcision is that it is still tolerated in Western and other parts of the world, rendering it politically acceptable."
This tended to lower ethical barriers to recommending male circumcision as an HIV/Aids prevention measure.
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