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CIRCUMCISION IN INDIA: TAKING THE ROAD LESS TRAVELED

Tuesday, 14th of June 2011

There is an immediate need to focus on circumcision as an important public health intervention at least coupled with the other preventive strategies like condom use, delayed sex onset, lesser number of partners, STDs management, HIV testing and counseling, and it can adequately reinforce our fight in preventing the HIV epidemic. Year : 2010  |  Volume : 54  |  Issue : 4  |  Page : 228

Circumcision in India: Taking the road less traveled

Dilip Gude
Registrar, Internal Medicine, Medwin Hospital, Hyderabad, Andhra Pradesh - 500 001, India

Correspondence Address:
Dilip Gude
Registrar, Internal Medicine, Medwin Hospital, Hyderabad, Andhra Pradesh - 500 001
India

How to cite this article: Gude D. Circumcision in India: Taking the road less traveled. Indian J Public Health 2010;54:228

 

How to cite this URL: Gude D. Circumcision in India: Taking the road less traveled. Indian J Public Health [serial online] 2010 [cited 2011 Jun 9];54:228. Also available from: http://www.ijph.in/text.asp?2010/54/4/228/77268

It is surprising to see that circumcision, a practice so common in the West, ^[1] is restricted to a very small section of the community in India (Muslims contributing to 13% of the population). India, being one of the world's rapidly growing entities of HIV prevalence, needs an emergent look into the option of this relatively safe practice that has shown to reduce the HIV incidence by at least 60%. ^[2] With no vaccine or microbicide available currently and with antiretroviral treatment having only a meager effect on the spread of HIV, circumcision is definitely a mode of prevention that needs exigent attention. As a procedure, it is an inexpensive and rather simple means of prevention performed only once, and can be done on men over a wide age range. Amongst the many advantages of circumcision, of paramount importance is the decrease in sexually transmitted diseases (including HIV), penile carcinoma (if done early on), urinary tract infections and cervical cancer in female partners, as established by many studies. ^[3] There are various mechanisms postulated like keratinization of the glans, reduction of the total mucosal surface of the skin of the penis, reduction of target cells which are numerous on the foreskin, and fast drying after sexual contact, thereby reducing the life expectancy of HIV after sexual contact with an HIV-positive partner. A reduction in acquisition of other STDs may further indirectly reduce the HIV transmission. ^[4] Another indirect but potentially beneficial role is the protection conferred to women (and children born thereof) from HIV infection due to decreased incidence in men. Awareness in women of the protective effect of circumcision would further encourage their male counterparts to get circumcised, thus bolstering and spreading the impact of this practice. ^[4] Circumcision may also decrease the male to female transmission although further investigations are required to validate the same. Circumcision is a promising cost-effective prevention strategy with benefits comparable to that of a high-efficacy vaccine. There is a high degree of acceptance of mothers with male children to getting them circumcised as shown by a study from Mysore, ^[5] and we can reasonably extrapolate the same to larger populations in India if proper education about the benefits of circumcision can be disseminated effectively. There are religious/sensitive issues that need to be tackled in advocating circumcision as a routine practice, and to overcome such resistance, grass-root level education about the basic modalities of HIV spread and the mechanisms how circumcision helps prevent such spread need to be promulgated. There is an immediate need to focus on circumcision as an important public health intervention at least coupled with the other preventive strategies like condom use, delayed sex onset, lesser number of partners, STDs management, HIV testing and counseling, and it can adequately reinforce our fight in preventing the HIV epidemic.

References

 

1.	Xu F, Markowitz LE, Sternberg MR, Aral SO. Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: The National Health and Nutrition Examination Survey (NHANES), 1999-2004. Sex Transm Dis 2007;34:479-84.   [PUBMED]  [FULLTEXT]
2.	Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet 2007;369:657-66.   [PUBMED]  [FULLTEXT]
3.	Moses S, Bailey RC, Ronald AR. Male circumcision: Assessment of health benefits and risks. Sex Transm Infect 1998;74:368-73.   [PUBMED]  [FULLTEXT]
4.	Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2005;2:e298.   [PUBMED]  [FULLTEXT]
5.	Madhivanan P, Krupp K, Chandrasekaran V, Karat SC, Reingold AL, Klausner JD. Acceptability of male circumcision among mothers with male children in Mysore, India. AIDS 2008;22:983-8.   [PUBMED]