Guyana to advocate male circumcision in fight against HIV/AIDS
Kaieteur News
December 16, 2006

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Guyana will be taking strident steps to advocate male circumcision as an effective intervention in HIV/AIDS infections.

This announcement came from Health Minister Dr Leslie Ramsammy yesterday, even as international health agencies declared that the results of surveys revealed that medically performed circumcision significantly reduces a man's risk of acquiring HIV through heterosexual intercourse. “The world has identified a number of areas that are now recognised as prevention strategies for HIV, and therefore, our local intervention must include circumcision. We must ensure that enough information permeates through the mass communication to make it another option…We must ensure that adults become aware of this STI/HIV intervention and its results” The Minister posited.

According to Minister Ramsammy, it has always been a local public health policy to encourage circumcision at birth for boys.

He said efforts in this regard will be intensified.

The Health Ministry will also push for circumcision for grown men, he said.

It will include an aggressive public education and awareness initiative on the issue.

Preparations are also being put in place, at the public hospitals around the country, to accommodate the increased influx of patients seeking circumcision, which is anticipated once the added health benefits to be derived from this procedure begin to be acknowledged by members of the public.

A University of Illinois at Chicago study on circumcision and its impact on HIV/AIDS was stopped early, recently, due to preliminary results which indicated that medical circumcision of men reduces their risk of acquiring HIV during heterosexual intercourse by 53 percent, Dr Ramsammy said.

According to a Kenya newspaper report, similar trials in the African countries of Kenya and Uganda were also stopped early after an interim review by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) also revealed that a medically performed circumcision significantly reduces a man's risk of acquiring HIV through heterosexual intercourse.

The report added that the trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV infection in circumcised men relative to uncircumcised men; while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that infection by HIV was reduced by 48 percent in circumcised men.

The results of these studies indicate that circumcision is now a proven, effective prevention strategy to reduce the incidence of HIV infection in men.

Generally, uncircumcised men are thought to be more susceptible to the HIV because the underside of the foreskin is rich in Langerhans cells, sentinel cells of the immune system, which attach easily to the human immunodeficiency virus which causes AIDS.

The foreskin, also, often suffers small tears.

In the wake of these findings, the two largest agencies dedicated to fighting HIV/AIDS have announced that they would now be willing to pay for circumcisions.

They were not prepared to do so before, since there was too little evidence that it was effective.

Dr. Richard G. A. Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has almost $5 billion in pledges, said, in a television interview, that if a country submitted plans to conduct sterile circumcisions, “I think it's very likely that our technical panel would approve it.”

Meanwhile, Dr. Mark Dybul, executive director of President Bush's $15 billion Emergency Plan for AIDS Relief (PEPFAR), said in a statement that his agency, “will support implementation of safe, medical, male circumcision for HIV/AIDS prevention” if World Health agencies recommend it.

However, Minister Ramsammy cautioned that circumcision is no cure-all.

He noted that circumcision only lessens the risk of infection. It is also expensive, compared to condoms, abstinence, or other methods, he added.

He also pointed out that the surgery has serious risks if it is not performed properly.

Ramsammy added that, “Prevention efforts must reinforce the ABC approach – ‘abstain', ‘be faithful', and ‘correct and consistent use of condoms.' ”

Ramsammy also made it clear that circumcision should be used with other prevention methods, adding that it does nothing to prevent the spread through unprotected sex, the major form of transmission in Guyana.

The Minister posited that the sex education messages for young men will make it clear that circumcision does not mean that they have an absolute protection.

Another advantage of male circumcision is that it also benefits women.

A study of the medical records of 300 Ugandan couples last year estimated that circumcised men infected with HIV were about 30 percent less likely to transmit it to their female partners.

Earlier studies on Western men have shown that circumcision significantly reduces the rate at which men infect women with the virus that causes cervical cancer.

A study published in 2002 in The New England Journal of Medicine found that uncircumcised men were about three times as likely as circumcised ones, with a similar number of sexual partners, to carry the human papilloma virus.

According to Minister Ramsammy, the possibility of expanding the circumcision service to the health centres has not been ruled out.

But he stressed that promoting this procedure must be done in conjunction with proper technical training, and medical tools, equipment, and supplies necessary to perform large numbers of circumcisions safely.

Circumcision is the removal of all or some of the foreskin from the penis.(Melanie Allicock)