Back to Index

To circumcise or not to circumcise, that is the question
Albert Makone, HIV/AIDS Zimbabwe (HAZ)
July 20, 2012

http://www.hivaidszimbabwe.org/2012/07/20/to-circumcise-or-not-to-circumcise/

Download this document
- Acrobat PDF version (287KB)
If you do not have the free Acrobat reader on your computer, download it from the Adobe website by clicking here

In sub-Saharan Africa, heterosexual transmission of HIV is the primary driver for the epidemic. At the end of 2009, 33.3 million people were living with HIV/AIDS worldwide and of these, 67.6% lived in sub-Saharan Africa. Male circumcision is one of the strategies being advocated for HIV prevention. Debates are ongoing on the protective effect of male circumcision. The current article critically evaluates the evidence for circumcision against the backdrop of arguments presented by opponents of male circumcision. The review involved the use of published texts and documents. Arguments presented by Boyle and Hill (2011) on methodological concerns, ethical and legal concerns on the male circumcision randomised controlled trials done in Kenya, Uganda and South Africa, are evaluated. Current evidence shows that medical male circumcision is efficacious in preventing HIV infection and reduced morbidity and mortality from multiple sexually transmitted infections and genital cancers in men and their female sexual partners. Male circumcision has been shown to be cost effective. The current review concludes that current evidence supports the need to accelerate the implementation of medical male circumcision programmes for HIV prevention in high HIV burden countries.

Introduction

In sub-Saharan Africa, heterosexual transmission of HIV is the primary driver for the epidemic (Alistar & Brandeau, 2012). At the end of 2009, 33.3 million people were living with HIV/AIDS worldwide and of these, 67.6% lived in sub-Saharan Africa (UNAIDS & UNICEF, 2009). HIV/AIDS funding has been substantially affected by the global economic crisis with HIV prevention funds leveling off in the last decade and future funding commitments unclear. Funding constraints have created pressure on prevention programmes to be more accountable, by providing clearer evidence of cost effectiveness and delivering better value for money (Padian et al., 2011; Padian, McCoy, Balkus, & Wasserheit, 2010). Medical male circumcision is one of the prevention methods being rolled out in Africa. Male circumcision is the removal of the foreskin of the penis and it is one of the oldest, simple procedures that have been undertaken for religious, cultural, social and medical reasons (Westercamp & Bailey, 2007).

The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), in March 2007, recommended male circumcision as an efficacious intervention for the prevention of heterosexually acquired HIV infection in men (WHO & UNAIDS, 2007). In 2005 and 2006 randomized controlled trials in three African countries demonstrated that voluntary medical male circumcision (VMMC) reduced the risk of female-to-male sexual transmission by roughly 60% (Auvert et al., 2005; R. C. Bailey et al., 2007; R.H. Gray et al., 2007). Since 2007, both the WHO and UNAIDS have recommended that countries with generalized HIV epidemics and a low prevalence of male circumcision progressively expand access to safe voluntary medical male circumcision services (WHO & UNAIDS, 2011a). It is with this evidence that the WHO and UNAIDS identified 13 priority countries for the scale-up of VMMC: Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe.

The current article critically evaluates the evidence for circumcision against the backdrop of arguments presented by opponents of male circumcision (Boyle & Hill, 2011; Chin, 2011; Conroy, 2011; Darby, 2011; Darby & Van Howe, 2011; Forbes, 2011; Green et al., 2010; Paix, 2011). The review thus tries to address a question that many a contemporary African man must be asking himself: "To circumcise or not to circumcise?"

Visit the HIV/AIDS Zimbabwe fact sheet

Please credit www.kubatana.net if you make use of material from this website. This work is licensed under a Creative Commons License unless stated otherwise.

TOP