MALE CIRCUMCISION IN EIGHT AFRICAN COUNTRIES

Sunday, 12th of June 2011

EXCERPT FROM THE UN REPORT, 'AIDS AT 30: NATIONS AT THE CROSSROADS'

Medical circumcisions in eight African countries have risen to 350,000 per year from low baseline levels, according to this UN report. This, however, leaves millions of at risk males in eastern and southern Africa uncircumcised. Text below and at http://www.unaids.org/unaids_resources/aidsat30/aids-at-30.pdf page 66.

TEXT FROM UN REPORT:

'Over the past decade, a major tool for HIV prevention has emerged: voluntary medical male circumcision. To date, introduction of this breakthrough strategy has been slow, underscoring the need for urgent action to bring circumcision services to scale.

'At the time of the 2001 United Nations General Assembly Special Session, epidemiological patterns suggested that circumcised men might be less likely to become infected by HIV. However, no clinical trials had been performed that would provide definitive scientific evidence that medical circumcision of adult men reduced the odds of female-to-male sexual transmission.

'Beginning in 2005, a series of randomized controlled trials in sub-Saharan Africa found that circumsising adult men reduced their risk of infection by about 60%. These findings resulted in a major effort to introduce circumcision in settings with both high HIV prevalence and low levels of male circumcision. Male circumcision offers a partial reduction in HIV risk. Its main advantage is that, once performed, the risk reduction is life-long.

'The prevalence of circumcision varies considerably in sub-Saharan Africa. Although it is common in many areas, especially in West and Central Africa, most men are not circumcised in the Southern African countries most heavily affected by HIV. In nine countries in Southern Africa and four in Eastern Africa, less than 80% of adult men are circumcised. Outside Eastern and Southern Africa, only in the Central African Republic and Sudan are less than 80% of men circumcised.

'Circumcision prevalence varies also within countries, depending on cultural traditions. In Kenya, more than 90% of men are circumcised in all provinces except Nyanza Province, near Lake Victoria, where only 45% of men are circumcised. This pattern matches the distribution of HIV in Kenya, with Nyanza having substantially higher HIV prevalence than other parts of the country.

'Supported by international guidelines produced in 2007 by WHO and UNAIDS, 13 countries (Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe) prepared to introduce medical male circumcision, undertaking situation analyses and planning strategies for scale-up. Initial uptake was slow following the release of the guidelines, with slightly more than 100,000 men circumcised in eight (* Kenya, Malawi, Namibia, Rwanda, South Africa, Swaziland, Zambia, Zimbabwe) of the 13 priority countries in 2009. There are signs that the pace of scale-up is accelerating, with more than 350,000 men circumcised during 2010 in these eight countries, although tens of millions of men remain uncircumcised. Swiftest progress has occurred in Nyanza Province in Kenya, where a combination of strong political commitment and intensive outreach to community leaders has increased demand and facilitated access to medical circumcision services. A similar uptake has been apparent in South Africa, though most other countries in Eastern and Southern Africa have been slow to adopt or implement new policies for male circumcision.'