Circumcision can halve the risk of a man picking up the HIV infection which leads to AIDS, scientists in the US said on Wednesday.
Two major trials, in Kenya and Uganda, have confirmed what doctors and campaigners have suspected and hoped for several years. The results have major implications for the fight against the AIDS pandemic raging in Africa and Asia.
Kevin de Cock, head of the WHO's HIV/AIDS department, said it could cut the numbers of infected men by "many tens of thousands, many hundreds of thousands and maybe millions over coming years."
The two trials should have gone on into next year but were called to an abrupt halt by the funder, the National Institute of Allergies and Infectious Diseases (NIAID), after an interim review of the data showed a halving of the risk of infection among those circumcised. Now that the point is proven to the satisfaction of scientists it would be unethical to continue. All the uncircumcised participants will now be offered the medical procedure.
With a vaccine still decades away, the circumcision results are the best news in a long while out of the AIDS pandemic. But there are major questions still unanswered and a lot of work still to do.
Anthony Fauci, director of NIAID, said last night that the 48 percent reduction among men in the Rakai, Uganda, trial and 53 percent reduction among those in Kisumu, Kenya, "could be negated by small reductions in condom use or the addition of additional sexual partners."
It was vital, he warned, that people understood the need to continue to protect themselves by condom use and safe sex. Circumcision dramatically cuts the risk of HIV infection, but de Cock said: "It is not a magic bullet."
There was no sign that the 2,784 men in the Kenyan trial and the 4,996 men taking part in Uganda had become reckless in their sexual practices, Fauci said, "but now the announcement is out we are cognizant that there could be [an effect]."
Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, said the results were "a milestone in the history of the AIDS epidemic," but urged that circumcision be rolled out only in the context of other prevention measures.
There are other serious issues. Circumcision was carried out by skilled medical professionals in the trials and all those involved had aftercare. The WHO intends to tell governments they should ensure circumcision is carried out in a similar hygienic and skilled fashion.
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