Cutting Edge Prevention: Male Circumcision the new answer!

Final feedback from the International Aids Conference 2008 Mexico City

Within the prevention discussions at the IAC08, male circumcision has become highlighted as an important part of the response for the reduction of new transmissions of HIV.

Following the results of 3 randomised controlled trails developed and reported on the last few years, it is now agreed that the results showed ‘beyond doubt’ that male circumcision reduces transmission from Female to Male at a level of 60% effectiveness and calls are being now made for scale up of male circumcision (MC) as part of a preventive strategy.

So are we at a cutting edge of a break through for the prevention of new HIV transmissions?

Well the challenge is that Male Circumcision provides partial protection for HIV negative males, it provides very low protection for women and is useless for men already living with HIV and their partners. (There is no research on the effect of MC in MSM relationships). Additionally MC as prevention method provides no requirement of the man to change his behaviour but rather places great emphasise on the women to change hers - to protect herself, alone which takes place outside the normal advocacy of HIV prevention of joint responsibility and shared decisions in protection against HIV. Where does this leave women?

Before the development of scaled up MC programmes consideration needs to be given to clear messaging so that men in fact do not increase risk behaviour, that women have access to means of protection and that the safer sex campaign messages are not eroded. Additionally of course the procedures itself could open men up to risks and there is need for understanding of cultural and individual acceptance of MC.

So before the knives are sharpened ready for mass adult male circumcision this important progress in knowledge of HIV transmission prevention needs translating to gain further clarity as to how this possibly valuable and additional but singular prevention method can be fitted into the practical, inclusive and comprehensive prevention strategy.

Diane Moody & Alyson Lewis
7 August 2008