Male circumcision. felipe mejia. reproductive health and hiv advance module.

Male circumcision should be promoted in developing countries as a major means of HIV prevention.
Felipe Mejía
Master of Science in International Health
Reproductive Health and HIV/AIDS

Introduction

According to UNAIDS for its AIDS epidemic 2009 report, the total number of people living with HIV in 2008 was 33.4 million, among them 15.7 million of are women and 2.1 million children under15 years old. The same data reported 2.7 million new infections due to HIV in 2008 and 2.0 million deaths due to AIDS. Sub-Saharan Africa has the largest amount of people living with HIV accounting for 22.4 million with an adult prevalence of 5.2%. Of over 7400 new HIV infections a day in 2008, 97% are in low- and middle-income countries, 6200 are in adults (15-49 years old), 48% women.Comparing to 2001, there has been a reduction in the total new cases by 0.5 million.[i] Even considering that the new cases have decreased over the years between 2001 and 2008, HIV/AIDS remains as an important cause of mortality and morbidity in the world especially in the poorest regions. Due to its continue spread, developing new methods or extending existing ones which can protect large populationaagainst new infections are still urgent.

Male circumcision has been analyzed for the past years as a possible procedure to protect men on HIV infection. Indeed, three studies made in South Africa[ii], Kenya[iii] and Uganda[iv] have shown that it reduces the probability of getting infected by 50% making it as a possible tool for a national policy in developing countries. However, malecircumcision programs depend on different factors which must be under analysis according to particular cases.

Efforts similar to the mentioned above has been carried out previously for antiretroviral treatments, showing that the integration with national policies, the civil society, all non-governmental organizations and other different stakeholders as well as qualified health facilities and medicalproducts supply are required to achieve success. It is also important to stress that in non-endemic regions, male circumcision programs may not be significantly. However, for endemic places as it is in Sub Saharan Africa, the possible results may be greater. It was estimated for 2007 that in rural KwaZulu-Natal, South Africa, male circumcision would prevent an estimated 35 000 new HIV infections inthe 2·5 million men with the previous knowledge that most of them were circumcised.[v]

People’s acceptability:

In most of the countries in Sub Saharan Africa, male circumcision is common practice. Some studies[vi] have shown that 61% of men are willing to be circumcised and 81% of couples are willing to circumcise their male children. However, for regions where this is an uncommon practice,this intervention has more challenges and ethical in regarding to social, cultural and religious issues must be addressed carefully.

Male circumcision Prevalence

The prevalence of male circumcision does not necessarily depend on the presence of religious activities or a specific cultural basis as it is in some countries in Africa. Indeed, it does not depend also on differences betweendeveloped and not developed countries. In USA more than 80% of new born were circumcised in late 1970, 48% Canada and 24% UK. Yet USA has one of the highest prevalence of male circumcision as a routine procedure with 84 to 89% in the 80’s. [vii] In developing countries where male circumcision is a common practice for social or non social reasons, it is important to establish what the prevalence is inorder to set a base line for a future intervention.

Information, Communication, Education (IEC):

How to disseminate the information among the targeted people and integrate it to the other preventive programs? Considering that the protective effect has been estimated as 50% as mentioned above, the messages which want to get attention for the future circumcised men must make clear that male...