Circumcision can reduce HIV risk

2014-04-04 11:56

Last week Georgina Guedes published a column titled "Circumcision is not a particularly good way to combat Aids" in which she perpetuates the many myths of voluntary medical male circumcision (VMMC) instead of focusing on the evidence that it is highly protective against HIV and other sexually transmitted infections.

In 2008, I participated in a World Health Organisation (WHO)/Unicef meeting on VMMC for young people in Africa. One of the key messages that I took out of this meeting was that VMMC reduces men's risk of acquiring HIV from their female partners by approximately 60%, as Ms Guedes forthrightly acknowledges. Long-term follow up data from South Africa show this protection increases over time to around 75%.

South Africa is one of the three countries, along with Kenya and Uganda, in which male circumcision for HIV prevention was evaluated in large-scale clinical trials that enrolled a total of about 10 000 men. Each of these trials used surgical techniques that had proven safe and effective over years of use in other contexts. The outcomes of these trials came with a strong emphasis on correct and consistent use of both male and female condoms.

Long-term benefits

So when Ms Guedes falsely accuses the Minister of Health Aaron Motsoaledi of taking to the airwaves to promote VMMC over condom use, she is perpetuating a false dichotomy. In fact, VMMC programs, as recommended by WHO, are rolled out as part of a comprehensive package of HIV prevention. It is a unique opportunity to reach millions of men with HIV testing, risk-reduction counselling, condoms and linkages to care and treatment and eventual viral suppression for men testing HIV positive (or previously diagnosed with HIV but not engaged in care).

Perhaps this is why most studies show an increase in condom use among recently circumcised men and no increase in the number of sexual partners. The increase in condom uptake might also be due to easier use post-circumcision, as reported by men and their partners.

It is quite sad that Ms Guedes not only views VMMC in South Africa as a detraction from condom use, but she also fails to contextualise its gains. I am proud of the one million plus men who have sought circumcision in this country. Long-term benefits of VMMC on the population level are starting to pan out: New data from Orange Farm show VMMC significantly reduced HIV levels in the community in both men and women. It is logical that women’s risk is reduced when fewer men in their community have HIV. Ms. Guedes’ concerns that women don't benefit from VMMC are outdated.

Promoting one solution

Perhaps the most egregious of all Ms Guedes's myth making is her assertion that "a responsible man uses a condom every single time, unless he's in a committed relationship and trying to have a baby". She acknowledges HIV prevention benefits of VMMC, therefore I don’t understand how she would then view this as not taking responsibility.

Furthermore, Ms Guedes is guilty of the very thing she wrongly accuses the Health Minister of - promoting only one solution, while discarding the rest. The majority of men still do not practice condom use in South Africa, as the author admits. To rely on this one intervention instead of expanding the prevention toolbox does not work.

We need to scale up VMMC simply because it works. This is why Ms Guedes sees the Minister of Health publicly hailing its merits. He should be loudly applauded, not discouraged. I am happy to engage Ms Guedes further on VMMC in South Africa. I hope she would be open to learning the facts around this very important combination strategy for HIV prevention.

- This rebuttal has been written by Khanyisa Dunjwa in her personal capacity. Follow  @DunjwaKhanyisa on Twitter.

Disclaimer: News24 encourages freedom of speech and the expression of diverse views. The views of columnists published on News24 are therefore their own and do not necessarily represent the views of News24.

  • oi - 2014-04-04 12:39

    Being circumcised will still NOT stop the spread of AIDS. It might limit some infections, but of itself, will not do the trick. It is a false message.

  • Cees Bleker - 2014-04-04 12:40

    The fact that VMMC reduces 60% risk of getting HIV still holds in that 1 in 3 poeple are at risk of getting infected , this is like playing Russian Rolette, were as condom useage gives you ,say, 99%. A much better odds at the rolette table

  • El Torro - 2014-04-04 12:41

    I see the way you say most it not the fact that Kalichman et Al 2007 reported that in a South African trial, the recently circumcised had 18% more sexual contacts than the uncircumcised at follow up? Ultimately you can find stats to support anything and governments are well known for manipulation of stats. I'd also like to point out that your beloved WHO also state that Male circumcision may not prevent Male to female infections because its only partial protection.....its my understanding that condoms offer a much higher level of protection, should we not be aiming for perfection and catching excellence rather than aiming for 60%? Perhaps the biggest thing with this and this is where I agree with Georgina, you slate Georgina because she chooses to focus only on condom use neglecting the rest of the "toolkit"....The minister of health is doing exactly the same, he makes no mention of condom use, councilling, behaviour or any of the rest of the "toolkit" in his fancy ads and I'm very sorry but to your average ley person it can easily be misconstrued, especially when we are dealing with statistics presented to a nation with chronically low levels of mathematical literacy, a more responsible ad would have highlighted them all and stated that condoms have a higher level of protection.

      El Torro - 2014-04-04 12:44

      Oh and I'd just like to add, that from the point of view of say a man who has been circumcised as part of tribal ritual for instance and undergone none of the medical counseling etc.....what message is sent to them?

      El Torro - 2014-04-04 16:52

      No thanks I'd rather wear a rain jacket!

  • Bac Teria - 2014-04-04 14:21

    So is the risk reduction percentage measured across communities or just those who've undergone VMMC? As it is a voluntary procedure one can assume those who have it done is on the more intelligent side and know the risks associated with unsafe sex, thus only a 60% reduction in transmission is actually a pathetic statistic. I agree with other comments that the minister's messages is not detailed enough an can easily be misinterpreted.

      Jackie No - 2014-04-06 09:06

      It gets worse than that. The cut guys got condoms, and got condom advice. They also had a wounded member for at least 10 % of the study! There is no information about how many women they had sex with or which women they had sex with. And then take a step back. The population data shows that natural man and men with parts of their genitals cut off get HIV at about the same rate. So what is going on here? Btw 60% relative risk changes is actually a 1.27% risk change.

  • Bri - 2014-04-04 14:58

    Well, how about abstinence? that pretty much reduces your chance of being infected by 100% ! It is such a pathetic reason, rather educate yourself, and use the proper protection and not go around sleeping with any odd person you might bump into - stay clean, use protection. For goodness sake - the use of a condom will protect far more than circumcision. Have you ever heard of condoms before, they are those things which are also used to prevent unwanted pregnancies, and never mind all the other STD's which are being transmitted out there. So if you were clever - you would be faster to promote the use of condoms rather then having men run off and let someone have a good chop at their penises.

  • Robert Coughlan - 2014-04-04 15:33

    If the reduction in transmission and infection supposedly offered by circumcision is so utterly dependant upon the use of condoms and other safe practices, it's dishonest to make misleading claims about it's benefits as if it is some kind of revolutionary silver bullet in the fight against HIV/AIDS. There appears to be some cultural bias and apparent conflict of interest amongst certain proponents of MMC, which call to question the objectivity of the studies being cited as evidence. Given that the practice is by no means independantly effective in any significant way, and there are numerous other means of transmission and infection, the trauma it induces and the potential devastating physical and psycho-sexual effects, it probably doesn't have a fraction of the value it's said to have. So it slightly reduces the exposed Langerhans cells...whoop-de-doo...there's heaps of these on the shaft as well. Certain degrees of Female Genital Mutilation would offer the same reduction of exposed Langerhans cells by removing the labia (not the clitoris). How would the girls like that? Thought not. Condoms are objectively effective. The supply of these in abundance, and the raising of awareness of condom use would go so much further than this drastic measure. Efforts to shame men into having this procedure carried out are ignorant. h t t p://w w h t t p://w w

  • Frederick Newman - 2014-04-04 16:23

    VMMC is a myth. How voluntary is it, when someone is holding a death threat in front of you. Wouldn't it be better to offer a man condoms, rather than surgery which is not going to prevent HIV, but which removes between 50% and 80% of the skin of his genitals? Condoms actually prevent disease.

  • Jackie No - 2014-04-04 16:32

    Cutting genital parts of men has never been shown to prevent HIV infection in real populations. Records from the US Veterans Administration show there is no difference at all in the likelihood of HIV infection between cut and natural men. Research DOES show circumcision affects sexuality. Fine-touch medical instruments were used on the penis in the U.S. and China and found circumcision removes the most sensitive part of the penis. The sexual pleasure aspects of the parts are clear to anyone that has all of the natural parts. Test this by pulling back your foreskin and running the back of a fingernail over your glans and then over your inner foreskin. The inner foreskin has the main pleasure nerves. If you cut off parts of your penis you will lose that sensation. Doesn't anyone else find it odd that men missing the parts since childhood say that the parts are not important? Why isn't this as silly and laughable as a color impaired person telling those with color sight that the color sense is not important?? Does anyone know and male medical professional that has all of their penis that also recommends routine infant penis parts cutting??? As almost no men that have the parts want them to be amputated, we should not do that to a days old human male. As it leads to sexual dysfunction and has no benefit, it should never be forced on anyone, especially babies.

  • James Loewen - 2014-04-04 19:18

    Cutting off the mucosal area of the genital of a human being MIGHT reduce risk of contracting HIV but most certainly does NOT stop or deter transmission. Cutting the genitals of an infant or child with the excuse of "preventing HIV' is a violation of that child's most basic human right to bodily integrity. The author of this (and those of other articles) that support the highly questionable JUNK SCIENCE and MEDICAL FRAUD behind the African circumcision campaign need to be asking far more invasive questions. Why does the USA with its large population of men who were cut as infants have one of the developed world's highest rate of HIV infection, while many countries in which most people are intact have very low rates of HIV infection? Follow the money and you will find the recipients in Africa driving expensive SUV's and living in the best houses. The campaign to cut others is supported by those who have been cut. Forced or coerced circumcision is constantly looking for medical justification. AIDS is the latest excuse.

  • Ron Low - 2014-04-05 03:48

    Most of the US men who have died of AIDS were cut at birth. The US has three times the HIV incidence seen in Europe, where circumcision is rare.

  • fredpotgieter - 2014-04-05 13:59

    Circumcision probably can reduce the chance of getting HIV if you don't believe in soap and water.

  • Ron Low - 2014-04-05 18:51

    Most of the US men who have died of AIDS were circumcised at birth. The US has three times the HIV incidence seen in Europe where circumcision is rare. In half of African nations it is the circumcised who have markedly higher HIV incidence. In the ONLY controlled trial of circumcision and male-to-female HIV transmission, cutting men INCREASED the risk to their partners by 50%. Circumcision to fight HIV is a dangerous lie.

  • Richard Young - 2014-04-07 21:25

    Just don't act like Zuma and you're sorted, don't have to worry about HIV. That's the problem these days, the public is taught ways to lower risk of infections and diseases but gone are the days of good morals

  • ShoSho - 2014-04-08 04:09

    Reduce the number of shebeens, nightclubs and outlets selling alcohol. I'm an ex bouncer of 11 years. No circumcised penis is gonna protect you when the girl or guy you're taking home was part of a gangbang in the last month. AIDS is a serious thing. These neatly wrapped solutions backed up by convenient stats do not correlate with the lifestyles that lead to contracting the virus. It's kinda like those the 80's he had too much energy. In the 2000's he has ADD. If you're a ho, male or female or if shoot your drugs up, no circumcised penis gonna save you. This will get deleted. But it's the truth.

  • Mccart Kate - 2015-03-17 06:11


  • Mccart Kate - 2015-03-17 06:11


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