[afro-nets] Male circumcision Halves HIV Risk (2)

["Emmanuel Otolorin" <eotolorin@jhpiego.net>]

Male circumcision Halves HIV Risk (2)
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Hi everyone,

At last, we now have three randomized controlled trials of male circumcision and HIV showing overwhelming evidence that male circumcision is protective against HIV infection. When in 2002, stakeholders gathered in Washington DC to review the evidence linking lack of male circumcision with HIV acquisition and transmission and to examine the programmatic implications of such a linkage, many chose to be very cautious and supported the postponement of acceptance of the procedure as a public health intervention. It was then decided that further action should await the conclusion of 3 ongoing randomized controlled trials looking at the relationship. When the results from the Orange Farm RCT in South Africa was released last year showing a 61-65% protection against HIV infection, again, it was decided that we needed more results before moving ahead with the acceptance of MC as a major public health intervention against HIV. Today's decision of the NIH to prematurely halt  the Kenya and Ugandan RCTs because it will no longer be ethical to continue to deny participants access to the procedure based on the overwhelming protective effect, has removed all the excuses against the widespread adoption of this prevention intervention. 

In Africa, we cannot indulge in those activist antagonism to a procedure than can save many lives on the continent.  For countries with an HIV prevalence rate of less than 1% such luxury may be allowed. For us in Africa, our immediate concern should be how to immediately move from research to practice  through the provision of safe, painfree and affordable MC services for our people. Further more, we also need to ensure that the message that goes out about MC stresses the fact that it does not provide 100% protection and that the concepts of the ABC-Plus approach remains relevant. There should be no disinhibition generated by the widespread adoption of MC as a public health intervention. 

Finally, for many years we have advocated for male involvement in reproductive health. Adult and adolescent MC provides us the unique opportunity to introduce other important male RH issues like safer sex, screening and treatment for sexually transmitted infections, family planning (or healthy and timely spacing of pregnancies), gender based violence, support of women during pregnancy, childbirth and in the postpartum period and postabortion care. MC should be our new-found entry point to all of these other male RH services. Let's seize the opportunity now and kill two birds with one stone-perform MC and get our men more involved in RH. Comments are welcome.  

'Dipo

--
Emmanuel Oladipo Otolorin, FRCOG
Country Director/ACCESS Nigeria Chief of Party,
JHPIEGO Corporation: an affiliate of Johns Hopkins University,
12A Kainji Crescent, Off Lake Chad Crescent,
Maitama,
Abuja, FCT,
Nigeria
Mobile: +234-803-478-3549
Email: mailto:eotolorin@jhpiego.net