[Rhodes22-list] Health - What's in a name?

[Brad Haslett]

Ok, Ok,

I know this is a serious subject but I almost fell out of my chair laughing
when I got to the doctor's name quoted in the article.  You'll have to read
the article, I'm not giving you this laugh for free!

Brad













   *Keith Alcorn*, Wednesday, March 28, 2007
 The World Health Organization and UNAIDS are to recommend that circumcision
programmes should become part of HIV prevention programmes in countries
seriously affected by HIV, following an expert consultation earlier this
month.

But experts warned that circumcision must not be relied upon as the sole
means of protection against HIV, and Dr Kevin De Cock of the World Health
Organization's HIV department said that it will take "a number of years"
before money spent on circumcision programmes will translate into any
slowing of the epidemic.

Circumcision provides "important but incomplete protection" against HIV,
said Dr De Cock, and is an "important but additional strategy" for HIV
prevention programmes.

"It is partial protection for men, it's not to be scoffed at. We haven't had
news like this in a long time," said Catherine Hankins of UNAIDS. "But it
does not replace the need for promotion of safer sexual practices."

"High HIV prevalence, low circumcision prevalence countries with high rates
of heterosexual transmission should consider adopting circumcision as a
priority," said Dr De Cock. "We are primarily talking about the countries of
southern and eastern Africa."

"The first consideration should be to scale-up circumcision for adolescents
and young sexually active men. Although circumcision in babies and young
children is an important consideration, it will take 15 to 20 years to see
the benefits."

"Scale up will take a long time and for this to have a population-level
effect, coverage will have to be very high – we're talking about [rolling
this out over] the next ten to twenty years," Dr De Cock went on.

Asked whether circumcision should be recommended for all HIV-negative men,
not just men in countries with high HIV prevalence, Catherine Hankins said:
"For individual men there can be a real benefit immediately."

Widespread changes in cultural attitudes would be needed, said Kim Dickson
of WHO. However, it was important that any changes did not affect the human
rights of males.

"It's very important that we don't create a new stigma around circumcision
status," said Catherine Hankins. "In the case of adolescents, it's important
that parents and health care providers recognise their evolving capacity to
assent or withhold consent for the procedure."

Spokespersons for WHO and UNAIDS stressed that it would be up to individual
countries to decide how to implement circumcision programmes. Once national
assessments have been conducted, said Catherine Hankins, "PEPFAR, the Global
Fund and the World Bank have all indicated they would be willing to fund."

WHO and UNAIDS are recommending that circumcision should be provided at no
cost or at the lowest possible cost, and that it should be performed by
medically trained personnel in order to reduce the risk of complications.

*The evidence for circumcision*
There is now strong evidence from three randomised controlled trials
undertaken in Kisumu, Kenya, Rakai District,
Uganda<http://www.aidsmap.com/en/news/376EF102-A6E5-408F-A671-789D7B325CCD.asp>(funded
by the US National Institutes of Health) and Orange
Farm, South Africa<http://www.aidsmap.com/en/news/BA448CC3-7935-43E6-947C-987D69B82D54.asp>(funded
by the French National Agency for Research on AIDS) that male
circumcision reduces the risk of heterosexually acquired HIV infection in
men by approximately 60%.

It has also been shown to reduce the risk of HIV transmission from
HIV-positive men to their uninfected female partners by around
one-third.<http://www.aidsmap.com/en/news/376EF102-A6E5-408F-A671-789D7B325CCD.asp>in
one study, although Dr Kevin de Cock stressed that more data were
needed
before the procedure could be recommended for HIV-positive men.

A similar degree of reduction in risk has been seen in population studies
comparing the risk of HIV acquistion between circumcised and uncircumcised
men, and regions of Africa in which circumcision is widely practiced tend to
have much lower HIV prevalence.

"Many epidemiologists comment that they are very struck by the consistency
of all the data, both epidemiological and clinical," said Kevin de Cock,
noting that results in clinical trials often fail to be attained in the
field due to implementation problems.

"Here we are in the unusual situation of having real-world epidemiologic
data before the clinical trial data."

Recent evidence from the Rakai circumcision
study<http://www.aidsmap.com/en/news/4FB10898-6755-4B9E-9619-22EE8488BDFC.asp>suggests
that men with multiple partners may get the greatest benefit from
circumcision, partly because it reduced the risk of ulcerative sexually
transmitted infections. However the study also showed that the protective
effect grew over time, possibly due to the hardening of the skin on the head
and shaft of the penis after circumcision.

Evidence from another study carried out in
Kenya<http://www.aidsmap.com/en/news/281ADC9B-AB02-49BE-AC1E-6A986B5823B2.asp>also
suggests that circumcision does not result in an increase in risky sex
over time, a concern that has been raised by researchers, advocates and
politicains reacting to early study results. In addition, epidemiological
modelling based<http://www.aidsmap.com/en/news/62B0B005-7FCC-4515-848E-8FF8EAF78951.asp>on
the South African Orange Farm study has shown that even if condom use
among circumcised men fell dramatically, mass circumcision would still
reduce the HIV infection rate over time.

Epidemiological modelling has
suggested<http://www.aidsmap.com/en/news/74AF670A-F211-4DB3-A9C0-ECC8073D7202.asp>that
mass implementation of circumcision could avert up to
5.7 million HIV infections and 3 million AIDS deaths by 2026.