Circumcise males to reduce HIV - UN

Heterosexual men should undergo circumcision because of “compelling” evidence that it can reduce their chances of contracting HIV by up to 60%, according to UN health agencies.

However, World Health Organisation and UNAids experts in Geneva said men must be aware that circumcision is only partial protection against the virus and must be used with other measures.

“We must be clear,” said Catherine Hankins of UNAids. “Male circumcision does not provide complete protection against HIV.”

Men and women must continue to use other forms of protection such as male and female condoms, abstinence, delaying the start of sexual activity and reducing the number of sexual partners, she said.

Otherwise, they could develop a false sense of security and engage in high-risk behaviour that could undermine the partial protection provided by male circumcision, the agencies said.

Men also should be warned they are at a higher risk of being infected with HIV if they resume sex before their wound has healed, which can take six weeks. Likewise, an HIV-positive man can more easily pass on the disease to his partner if the wound is still unhealed.

The recommendations were based on a meeting earlier this month in Montreux, Switzerland, where experts discussed three trials – in Kenya, Uganda and South Africa – that produced “strong evidence” of the risk reduction resulting from heterosexual male circumcision.

The reason circumcision helps is that it reduces and toughens the foreskin, which is susceptible to the HIV virus and to ulcers and abrasions that can open the way to infection, according to the World Health Organisation.

“Based on the evidence presented, which was considered to be compelling, experts attending the consultation recommended that male circumcision now be recognised as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men,” a joint statement said.

The African trials confirmed what experts had long suspected because of lower HIV rates in Northern and Western African countries where circumcision has been widely practice for religious or cultural reasons.

Much depends on the situation in a given country, and little general benefit will result in countries where the HIV epidemic is concentrated among sex workers, injecting drug users or men who have sex with men, the agencies said.