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| WHO recomends circumcision to prevent AIDS virus | | | NEW DELHI, MAR 29
The World Health Organisation (WHO) has officially recomended circumcision as a way to prevent heterosexual transmission of the AIDS virus, setting the stage for donor agencies to begin paying for the operation. According to reports received in New Delhi, the WHO acted after the clinical trials in Kenya, Uganda and South Africa, overseen by the national health agencies of the United States and France, found that male circumcision reduced the risk of infection of men through heterosexual sex by about 60 per cent.
No countries have yet adopted circumcision as part of their AIDS prevention plans. “But I hope this recommendation will lead some to do so”, Dr. Kevin De Cock, director of the HIV-AIDS department of the World Health Organization, was quoted as saying. In some southern African countries with very high AIDS rates, such as Lesotho and Swaziland, Dr. De Cock said that he has already heard anecdotal reports that men were asking private doctors for the operation.
Large donors, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief, have already indicated that they will be willing to pay for circumcisions if countries ask for money and can demonstrate that the operations will be done safely and with the right counseling.
It is crucial, the WHO said, that men be taught that they can still catch the virus and pass it on even if they are circumcised, and so should still lower their risk further by having no sex or sex with fewer partners and by using condoms. The organization’s recommendation represents a triumph for a few public health experts who argued for years — in the face of skepticism from prominent scientists — that circumcision had a protective effect. They had noticed that AIDS rates were lower in African regions where it was common, such as Muslim areas. But, until the recent clinical trials, it was impossible to convince mainstream experts that the lower rates were not because of other factors, like polygamy or harsh penalties for extramarital sex under Shariah, the legal code of Islam based on the Koran.
“It’s a big day”, said Dr. Daniel Halperin, an AIDS researcher at the Harvard School of Public Health who was an author of a 1999 paper in the journal The Lancet arguing that evidence for a protective effect could be found in many small surveys of African sexual habits. “They finally said what we suggested years ago”. Dr. Halperin, who said he had interviewed hundreds of African men about sex and AIDS, said he had seen growing acceptance of circumcision among those whose tribes or religions did not practice it.
The countries where the operation is likely to do the most good — those where AIDS prevalence is high and circumcision is low — are places like South Africa, Botswana, Swaziland and other southern countries that have, by African standards, good health care. “They can do it safely”, Dr. Halperin said. “It’s surgery, but it’s not brain surgery.”
Scientists are not sure why circumcision reduces the risk of AIDS, but the prevailing theory is that Langerhans cells, which are the immune system’s sentinels and attach easily to viruses, are much more common on the underside of the foreskin than on the shaft of the penis. Also, the foreskin suffers small tears during intercourse, which may allow the virus into the bloodstream.
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