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Malawi launches male circumcision programme
Malawi has adopted voluntary medical male circumcision (VMMC) as part of its HIV prevention strategy, Deputy Minister of Health Ralph Jooma announced in a speech at the official launch of the national VMMC programme on 8 October. He urged all men to take advantage of the new services, noting that even men with traditional (often partial) circumcisions could benefit from complete removal of the foreskin by a trained health provider. The programme was launched in one of the nine districts where Malawi will offer VMMC services—Mulanje—which has an estimated HIV prevalence of 17 percent (Tunikekwathu News, 10 October 2011).

 

Medical benefits of male circumcision
Efforts to defund or ban infant male circumcision in the USA are unfounded and could deprive vulnerable populations of proven health benefits, doctors from Johns Hopkins University write in a 5 October editorial (2011, PDF, 47 KB) published in the Journal of the American Medical Association (JAMA). They call on US medical bodies to re-evaluate the medical risks and benefits of male circumcision, based on recent scientific evidence confirming that the procedure reduces men’s risk of HIV infection through vaginal sex and that it protects men and their partners from several other sexually transmitted infections. “If a vaccine were available that reduced HIV risk by 60%, genital herpes risk by 30%, and HR-HPV risk by 35%, the medical community would rally behind the immunisation and it would be promoted as a gamechanging,” the authors conclude (LiveScience.com, 4 October 2011).

 

Obstacles slow promising HIV intervention
Male circumcision—one of the most promising, proven methods for preventing HIV in sub-Saharan Africa—is being implemented much more slowly than public health experts had recommended, The New York Times reports. The goal is to avert millions of HIV infections by reaching more than 20 million men in 14 African countries by 2015, but only about 600,000 men (less than 3 percent of the target) have been circumcised so far. Obstacles that have slowed voluntary male circumcision campaigns include lack of political or logistical support, cultural misconceptions, and in some countries requirements that doctors, not nurses or physician assistants, perform the procedure. Dr. Stefano Bertozzi of the Bill & Melinda Gates Foundation likens male circumcision to a 60 percent effective vaccine for men. “It’s clearly the most obvious, most cost-effective intervention we could use to dramatically change the course of H.I.V. in the near future,” he said (The New York Times, 26 September 2011).

 

Will Zimbabwe’s ministers get circumcised?
Zimbabwe’s deputy prime minister, Thokozani Khupe, has suggested that male cabinet ministers and legislators get circumcised to set an example for young men and boys to follow, BBC News reports. Studies have shown that male circumcision greatly reduces the risk of female-to-male transmission of HIV infection. So far, only one minister among eight interviewed has said that he plans to become circumcised; others greeted the proposal with skepticism, according to the BBC. One minister noted that whether to get circumcised should be an individual choice. Two female cabinet members backed Ms. Khupe (BBC News, 1 September 2011).

 

Gauteng province rolls out male circumcision
Health department officials in South Africa’s Gauteng Province plan to increase the number of public health facilities that can provide medical male circumcision from to 32 to 40 to help achieve their goal of reaching 125,000 men by March 2012. Since November 2010, about 8,000 men have been circumcised at the busiest of these facilities, the Zola Clinic Medical Male Circumcision Centre. The clinic’s operations manager noted that "for every five circumcisions that are performed, we potentially prevent one HIV infection.” Other officials cautioned that male circumcision alone will not turn the tide of the HIV epidemic and urged circumcised men and their partners to continue to practice safe sex (Health-e, 11 August 2011).

 

Precancerous lesions reduced among circumcised men
Male circumcision may reduce the risk of precancerous penile lesions associated with human papillomavirus (HPV), a study in Kenya found. The study, published in the International Journal of Cancer, was conducted among 275 of the men who participated in a larger trial of male circumcision for HIV prevention in Kenya. The prevalence of HPV-related precancerous lesions was 26 percent among uncircumcised men, compared to 0.7 percent among circumcised men. The author noted that this finding about male circumcision could be important to both men and women because such lesions may increase HPV transmission from men to their sexual partners. HPV is a sexually transmitted virus that can cause cancer of the penis and cervix (ScienceDaily, 28 July).

 

Study confirms male circumcision reduces HIV infections
Providing medical male circumcision in a South African township reduced the rate of new HIV infections among circumcised men by 76 percent in three years, scientists announced 20 July at the annual meeting of the International AIDS Society in Rome. The results of this study in Orange Farm confirm the findings of three randomised trials and are the first evidence of male circumcision's effectiveness in preventing HIV at the community level. The study, which involved household surveys among almost 1,200 men in 2007 and roughly the same number of men in 2010, also found a significant decrease in the percentage of circumcised men infected with HIV. There were no differences in reported condom use or other sexual behaviours between the circumcised and uncircumcised groups (Bloomberg, 20 July 2011).

 

Experts assess male circumcision scale-up
Countries that have been quick to incorporate male circumcision in their HIV prevention programmes are beginning to see results, experts said at the annual meeting of the International AIDS Society in Rome, Italy. PlusNews reports that a number of sub-Saharan countries have made progress toward achieving the goal of 80 percent coverage of male circumcision considered necessary for public health impact. Leading the way is Kenya, where about 290,000 men and boys have been circumcised since November 2008. Other countries in southern and eastern Africa have begun to expand access to male circumcision services. Several speakers emphasised that political leadership was key to the success of male circumcision for HIV prevention (PlusNews, 18 July 2011).

 

Swazi king endorses male circumcision
Swaziland's King Mswati III urged the men of his country to get circumcised to help prevent the spread of HIV infection, AFP reports. "It seems fitting that our men and young boys should be given an initiative that will help them fight this disease," he told thousands gathered in the southern Swazi town of Mankayane. A U.S.-supported campaign could prevent 90,000 new HIV infections by increasing the prevalence of male circumcision in Swaziland to 80 percent. But so far only 3,000 Swazi men have responded to the nation's "Circumcise and Conquer" campaign (AFP, 15 July 2011).

 

Medical male circumcision gaining acceptance
More than 90 percent of men and women interviewed in a traditionally circumcising community in Tanzania would prefer medical over traditional male circumcision for their sons, a study found. The study, published in the 23 May issue of BMC Public Health, was conducted among 170 men and 189 women in Tarime District, where traditional circumcision is an important stage of initiation for boys ages 10 to 18. However, more than 97 percent of the men and 94 percent of the women supported medical male circumcision for their sons. All but two of the men interviewed had been circumcised, and about 64 percent of the circumcisions had been performed in traditional settings. The researchers concluded that the community's shift in preference from traditional to medical male circumcision had not yet changed male circumcision practices.

 

Zimbabwe's programme gains momentum [UPDATED  8 August 2011]
Zimbabwe’s male circumcision programme is making up for lost time after a slow start toward the ambitious goal of circumcising about 1.2 million men of the country’s men by the year 2015, PlusNews reports. A delay caused in part by a health worker strike that lasted several months gave the programme time to launch a nationwide campaign to educate the public about medical male circumcision for HIV prevention; a survey in Zimbabwe’s rural areas found that 52 percent of the men were prepared to get circumcised. So far, 30,000 men have been circumcised (PlusNews, 4 July 2011).

 

Rwanda tests promising new device
Rwanda is investigating a nonsurgical device for performing adult male circumcision that does not require anaesthesia. The device, known as PrePex, could help Rwanda and other countries with limited health infrastructure rapidly expand access to male circumcision for HIV prevention. Data from a small safety and efficacy study are encouraging, but experts agree that further studies are needed before the device can be approved for more widespread use. A randomised controlled trial comparing PrePex with conventional male circumcision surgery is under way in Rwanda, with 150 participants. The World Health Organization has developed an evaluation framework and established an independent advisory committee to systematically review data from such studies of adult male circumcision devices (Scientific American, 16 March 2011).

 

Device research yields encouraging results
A disposable medical device for performing adult male circumcision called the Shang Ring is acceptable to men and safe for further study in Africa, a pilot study in Kenya found. Procedures performed with this device require no stitches and involve minimal bleeding. All 40 participants in the study said that they were satisfied with their circumcisions, and side effects were few, mild, and easily resolved. The mean time it took to perform the procedure was 4.8 minutes; 20 to 40 minutes are needed for conventional male circumcision surgery. The authors write that "with short procedure times, less surgical skill required, and the ease with which it can be used by nonphysicians, the Shang Ring could facilitate rapid roll-out of male circumcision in sub-Saharan Africa" (Journal of Acquired Immune Deficiency Syndromes,1 May 2011).

 

Botswanan women encouraged to promote male circumcision
An official from Botswana's Ministry of Health (MOH) urged women to encourage their partners and sons to be circumcised to slow the spread of HIV. Speaking at a health fair in Francistown, the MOH's Josephine Tlale cited evidence that male circumcision reduces men's risk of heterosexually acquired HIV infection by about 60 percent. For Botswana to realise the health benefits of safe male circumcision, she added, 80 percent of uncircumcised men in the country should undergo the procedure. So far, fewer men than expected have sought circumcision through a national campaign that is part of the government's HIV prevention program (Mmegionline, 19 April 2011).

 

Male circumcision: lessons from Kenya's first year
The first evaluation of the implementation of voluntary medical male circumcision (VMMC) in Kenya, conducted in two districts of Nyanza Province, offers lessons that may be useful to male circumcision programmes in other African countries. The results and lessons learned from a needs assessment of 81 health facilities and an evaluation of the first year of implementation are summarised in an article in the 4 April 2011 issue of the journal PLoS One. The article describes how challenges such as human resource shortages and low participation in HIV testing were addressed through national policy changes, while other challenges, such as large fluctuations in demand for services, were addressed locally.

 

Male circumcision offers lasting protection
Male circumcision continues to provide significant protection for men from heterosexually acquired HIV infection years after the procedure, said scientists reporting on a study from Rakai, Uganda, at the 18th Conference on Retroviruses and Opportunistic Infections. The study followed men who had participated in a randomised controlled trial of male circumcision for more than two years. Eighty percent of the men who had not been circumcised during the trial became circumcised at its conclusion. Among these men and the men circumcised during the trial four years earlier, the risk of HIV infection was reduced by 73 percent compared to the men who had declined to be circumcised at the end of the trial. The study also found no evidence that circumcised men were engaging in riskier behaviour compared to the uncircumcised men (MedPage Today, 28 February 2011).

 

Swaziland to launch ambitious male circumcision campaign
Swaziland aims to provide medical male circumcision to 80 percent of the country's men, reports Science Speaks. Beginning in March 2011, this ambitious campaign is designed to circumcise 152,000 men ages 18 to 49 by year's end. Swaziland has only seven facilities equipped to provide medical male circumcision, so many of these men will be served by mobile medical units. As a small country with very high HIV prevalence and a very low prevalence of male circumcision, Swaziland will provide an excellent case study of the relationship between male circumcision performed and HIV infections prevented (Science Speaks, 4 March 2011).

 

Male circumcision may reduce risk of cervical cancer
Having a male partner who is circumcised reduces a woman's chances of infection with high-risk forms of the human papillomavirus (HPV) by about 25 percent, according to a study among more than 1,000 Ugandan couples published in the 17 January 2011 issue of The Lancet. Persistent infection with high-risk HPV can cause cervical cancer in women and anal cancers in both sexes. Previous trials found that male circumcision reduces the risk of HPV as well as HIV infection in men. Now an analysis of HPV data from two randomised controlled trials of the effects of the procedure on HIV transmission to female partners has shown for the first time that male circumcision offers women some protection against the most dangerous forms of HPV. The study authors and the authors of a commentary on the study cautioned that this protection is modest, pointing to the need for additional prevention measures such as promotion of safer sex and greater access to HPV vaccines (The New York Times, 17 January 2011).

 

Kenyan campaign achieves rapid results
More than 50,000 men and boys were circumcised over 30 days during November and December 2010 in Kenya's Nyanza Province through the Rapid Results Initiative (RRI) for voluntary medical male circumcision programme, reports a 13 January 2011 article in the Nairobi-based Standard. The Nyanza provincial commissioner reported that the RRI campaign exceeded its goal of serving 41,000 clients and achieved another important objective of reaching primarily those older than 15, who are at greater risk of HIV infection compared to boys and young teens. Almost half of the 36,000 men and boys circumcised over 30 days during the first RRI in Nyanza in 2009 were younger than 15. Since the programme began in late 2008, 230,450 men and boys have been provided circumcision and related HIV prevention services in Nyanza.

 

Free services spark demand for male circumcision in Uganda
Hundreds of men in northern Uganda have come to hospitals to be circumcised since the government began offering the procedure for free in three districts, PlusNews reports. Nationally, about one out of four Ugandan men are circumcised, but the male circumcision rate is as low as 2.4 percent in some northern sub-regions and the proportion of adults infected with HIV in northern Uganda (8.2 percent) is higher than the national HIV prevalence of 6.2 percent. More than 1,300 men have been circumcised in the Apac District since free services were instituted there in September 2010. More recently, during the first week of the programme in two additional northern districts, 100 men registered to become circumcised in Gulu and 250 were circumcised in Lira (PlusNews, 22 December 2010).

 

Circumcision may not protect gay men from HIV
Although male circumcision reduces men's risk of acquiring HIV through heterosexual sex, it may not have a protective effect for men who have sex with men, a new study suggests. The study, published online ahead of print by the journal AIDS, found that being circumcised did not reduce the risk of contracting HIV among 1,800 gay and bisexual men in the USA and Peru. The study did find a 69 percent reduced risk of HIV among circumcised men who reported being the insertive partner at least 60 percent of the time with their last three partners, but this result could be due to chance. The authors recommend studies in more diverse populations to explore whether circumcision has a protective effect in men who primarily have insertive sex with other men (Reuters Health, 7 December 2010).

 

Male circumcision funding boosted in South Africa
A new grant to South Africa from the Global Fund to Fight AIDS, Tuberculosis and Malaria will provide $33 million to expand access to medical male circumcision for HIV prevention in underserved areas, the South African Press Association reports. The grant of up to $302 million is the largest ever awarded by the Global Fund, Health Minister Aaron Motsoaledi said. It is the first Global Fund grant to South Africa to cover AIDS treatment, with $196 million earmarked for that purpose, and it sets aside $10 million to strengthen health systems and community responses to HIV/AIDS (News 24, 19 December 2010).

 

Zulu king to honour circumcised men
Some 18,000 men who have been circumcised recently in KwaZulu-Natal, South Africa, will be honoured by being conferred the status of a regiment, the Sowetan reports. Zulu monarch King Goodwill Zwelithini invited the men to his palace to receive this honour, which is a traditional way of recognising the achievements of groups in Zulu society. The king has supported medical male circumcision as an important intervention against HIV in his province, which is home to 1 million of the estimated 5.5 million South Africans living with the virus (Sowetan, 7 December 2010).

 

Male circumcision offers long-term protection
Male circumcision provides sustained protection against heterosexually acquired HIV infection in men, researchers from the Universities of Nairobi, Illinois, and Manitoba (UNIM) Project reported in a presentation at the XVIIIth International AIDS Conference in Vienna, Austria. Results from an ongoing study revealed a 66 percent reduced risk of HIV infection among circumcised men compared to uncircumcised men after four-and-a-half years of follow-up. This observational study follows a cohort of about 1,500 men who participated in the randomised controlled trial of male circumcision for HIV prevention that was conducted in Kisumu, Kenya.

 

Gates: male circumcision a cost-effective HIV intervention
Bill Gates called for rapid scale-up of cost-effective HIV prevention measures such as male circumcision and prevention of mother-to-child transmission in a July 19 speech at the XVIIIth International AIDS Conference. The Microsoft founder added that these two interventions are so cheap and effective that it is more expensive not to pursue them. "In a single month last year in Kenya, 36,000 men were circumcised, and this cost 1.4 million dollars," he said. "If these men had not been circumcised, and later some of them became infected with HIV at the prevailing rate for uncircumcised males in that country, treating them would have cost the government over ten times as much" (The Wall Street Journal, 19 July 2010).

 

Male circumcision roll-out proves feasible
High-quality male circumcision services can be provided quickly and safely in low-resource settings, researchers reported in a presentation at the XVIIIth International AIDS Conference and in a 20 July article in the journal PLoS Medicine. From January 2008 to November 2009, 14,011 men—almost 40 percent of uncircumcised adult males in the community—were circumcised at the site in Orange Farm, South Africa, where one of the randomised controlled trials of male circumcision was conducted. The rate of complications after surgery was low at 1.8 percent.

 

Uganda to launch male circumcision programme
The Ugandan government will begin a nationwide male circumcision programme in July, offering the procedure as an HIV prevention measure at national referral hospitals, district hospitals, and county-level health centres with the capacity to perform minor surgeries. Only about one in four Ugandan men are circumcised. However, the acceptance rate for male circumcision is a relatively high 60 percent among eligible clients at the Rakai Health Sciences Programme (RHSP), a medical research facility that was one of the three sites for the clinical trials of male circumcision for HIV prevention (IRIN, 29 June 2010).

 

Kenya expands male circumcision efforts
The Kenyan Ministry of Health aims to provide male circumcision for HIV prevention to about 1,000 men ages 18 and older in Nairobi's Kibera slum, AfricaNews reports. Previously, the government had introduced a voluntary medical male circumcision programme in predominantly noncircumcising Luo communities in Nyanza Province to combat the spread of HIV infection. This programme, which provides medical male circumcision and other HIV prevention services such as HIV counselling and testing, is now expanding to Kibera and other parts of Kenya (AfricaNews, 30 June 2010).

 

Zulu king promotes male circumcision
Zulu King Goodwill Zwelithini is reviving the tradition of male circumcision to help prevent the spread of HIV in South Africa's KwaZulu-Natal Province, where one in seven adults are infected with the virus, CNN reports. The article follows a patient who got circumcised at Edendale Hospital, where extra beds have been brought in to help keep up with the demand for medical male circumcision. The king supports the provision of male circumcision at medical facilities, where it is offered as part of a package of HIV prevention measures (CNN, 1 July 2010).

 

South African president says he got circumcised
South African President Jacob Zuma has been circumcised and has encouraged his sons to undergo the procedure, The New York Times reports. In April, President Zuma announced a vast expansion of HIV testing and other HIV/AIDS services, including male circumcision for HIV prevention. South Africa's effort to provide male circumcision to millions of men began in the province of KwaZulu-Natal, home to the Zulu ethnic group to which Zuma belongs. In December, Zulu King Goodwill Zwelithini called for a return to the tradition of male circumcision, which was banned by another Zulu king in the 19th century, but also endorsed its provision by trained health care providers rather than traditional practitioners (The New York Times, 14 May 2010).

 

Zimbabwe aims to circumcise 1.2 million men
Zimbabwe needs to circumcise 1.2 million men by 2015 to achieve a national impact on the HIV epidemic, health officials told participants at a two-day workshop to discuss the roll-out of the country's male circumcision strategy. Achieving this goal could avert 75,000 new HIV infections in the next five years, they said. The officials stressed that male circumcision does not offer complete protection against HIV and that it must be combined with other HIV prevention measures, such as condom use, abstinence, and mutual fidelity. More than 5,000 Zimbabwean men have been circumcised through a pilot program that began in 2007 (The Herald, 5 May 2010).

 

Awareness of male circumcision in Uganda varies by age, education
In a study conducted in three rural districts in Uganda, awareness of male circumcision for HIV prevention was higher among adults than it was among youth, at 87 percent compared to 76 percent. Among the 267 men and women older than 24 years who were surveyed, a higher level of education, younger age, and being male were associated with greater awareness; among the 185 male and female youth ages 14 to 24 years, no social or demographic factors had a significant effect on awareness. The authors concluded that Ugandan youth, women, and those with lower levels of education "should be increasingly targeted by information campaigns" about the health benefits of male circumcision (BMC Public Health, 26 April 2010).

 

South African anti-HIV campaign includes male circumcision
In April the South African government began providing male circumcision services on a large scale during a nationwide campaign against HIV/AIDS, Sify News reports. By 2011, the campaign aims to reach 15 million South Africans with HIV counseling and testing, condom promotion and distribution, and male circumcision services. According to the article, Minister of Health Aaron Motsoaledi, who is a medical doctor, has pledged to perform 1,000 male circumcisions. His department aims to provide medical circumcision services to 2.5 million men by 2015 (Sify News, 31 March 2010). Africa.com reports that the campaign will begin in Kwazulu-Natal, where late in 2009 Zulu King Goodwill Zwelithini called upon Zulu men to return to the ancient practice of male circumcision but to have it performed medically for HIV prevention.

 

Circumcision and HPV in HIV-negative men
Male circumcision reduced the risk of acquiring the high-risk types of human papillomavirus (HR-HPV) that can cause genital cancers and increased the clearance of such infections, according to an analysis of data from a randomised trial among 800 HIV-negative men in Uganda. Being circumcised reduced the men's risk of acquiring HR-HPV infection by about one-third over two years, and it cut the risk of infection with multiple types of HR-HPV by 55 percent. Circumcised men were also more likely to clear HR-HPV infections than were uncircumcised men. These results suggest that male circumcision may reduce women's exposure to HR-HPV through its protective effect for men; the researchers are evaluating whether it actually reduced transmission of HR-HPV to the female partners of men in the trial (Journal of Infectious Diseases, 6 April 2010).

 

Circumcision and HPV in HIV-positive men
An analysis of data from a randomised trial among 210 HIV-positive men in Uganda found that male circumcision reduced their risk of multiple infections with the types of high-risk human papillomavirus (HR-HPV) that can cause genital cancers. Being circumcised did not, however, affect the acquisition of single HR-HPV infections or speed the clearance of any HR-HPV infections. The 23 percent reduction in the prevalence of multiple HR-HPV infections among the circumcised HIV-positive men was similar to the protective effect (against any HR-HPV infection) of about 35 percent shown after circumcision in two previous trials among HIV-negative men. The authors conclude that male circumcision provides a direct benefit to men who are infected with HIV and may also benefit their sex partners (Journal of Infectious Diseases, 6 April 2010).

 

Male circumcision cost-effective for HIV prevention
Adult male circumcision is a cost-effective and potentially cost-saving method of HIV prevention in sub-Saharan Africa, a systematic review concluded. Five economic evaluations published between 2006 and 2009 met the review's criteria; all found that male circumcision was cost-effective for the prevention of heterosexually acquired HIV infection in African men. The reported cost per HIV infection averted ranged from US $174 to US$ 2,808 over 10 to 20 years. The review makes recommendations for future economic evaluations of male circumcision for HIV prevention (PLoS One, 10 March 2010).

 

Tracking the rollout of male circumcision services
Most of the 13 countries in eastern and southern Africa identified as priorities for rolling out male circumcision for HIV prevention have begun providing these services at some level. According to PlusNews, about 135,000 men were circumcised in nine of these countries in 2009; the largest-scale effort is in Kenya, which launched its programme in late 2008 and had reached 90,000 men with male circumcision services by the end of 2009. The article summarises the 13 countries' progress in developing and implementing male circumcision policies (PlusNews, 2 March 2010).

 

Male circumcision and women's risk of HIV
A prospective study that followed 1,096 HIV-positive men and their HIV-negative partners in seven African countries found that male circumcision posed no increased risk and potentially decreased the risk of male-to-female transmission of HIV. Circumcised men were 40 percent less likely to pass on the virus to their female partners compared to the uncircumcised men, but this difference was not statistically significant and could have occurred by chance. Results of other prospective studies on this question are conflicting; the most rigorous study—a randomised controlled trial—found no direct benefit to women and possible increased risk to a woman if a couple resumes sex before the man's circumcision wound has healed. Women do benefit from male circumcision, because it reduces HIV infection in men, thus limiting women's exposure, and because having a circumcised partner reduces a woman's risk of other sexually transmitted infections and cervical cancer (AIDS, 13 March 2010).

 

Safety of infant circumcision
Circumcision of infants results in few side effects when performed by experienced health care providers, a systematic review of 52 studies in 21 countries concluded. In the 16 studies in 12 countries that had the strongest type of study design, the frequency of mild side effects such as bleeding and swelling was low, and the median frequency of any side effect was 1.5 percent. Serious complications of the surgery were rare. Mild or moderate complications were more common when circumcision was undertaken after the first year of a boy's life or when it was performed by inexperienced providers or in non-sterile conditions (BMC Urology, 16 February 2010).

 

3,000 men circumcised in Zimbabwe pilot
Three thousand men—three times as many as expected— became circumcised in a pilot programme conducted in Zimbabwe in preparation for the rollout of a national programme. The programme had expected to reach 1,000 men. Results from the pilot programme will guide the rollout of a national male circumcision programme, which will follow the launch of the government's five-year strategy on male circumcision for HIV prevention for 2010-14 (The Zimdiaspora, 5 February 2010).

 

New circumcision device assessed
A new device for performing male circumcision could aid efforts to expand access to the procedure for HIV prevention sub-Saharan Africa, the Associated Press reports. The device, known as the ShangRing and developed in China, was assessed in a small study among 40 men in Kenya. Researchers say that the device allows health care providers to remove foreskins without bleeding or stitches, making the procedure mostly painless and less time-consuming. A larger study of the ShangRing will begin in 2010 (article no longer available).

 

How does male circumcision reduce risk?
The reduced risk of HIV infection in circumcised men may be partially explained by a decline in the types of bacteria on the surface of the penis, suggest results from Rakai, Uganda, published in PLoS Medicine. An analysis of penile swabs collected from 12 HIV-negative men before and 12 months after circumcision found a marked decrease in anaerobic (non-oxygen-requiring) bacteria which are theorized to affect the risk of HIV infection. Together with the removal of the foreskin, which has a concentration of the type of cells most susceptible to HIV infection, this decrease in anaerobic bacteria may play a role in protecting against HIV and other sexually transmitted infections.

 

Kenya expands access to more than just a procedure
Receiving additional HIV prevention services is a routine "fringe benefit" of the male circumcision services offered by an ambitious programme launched in Kenya in November 2008 to increase the number of men provided these services, PlusNews reports. These standard services include voluntary HIV counselling and testing, routine testing for other sexually transmitted infections, STI treatment when needed, and instructions about how to use condoms. The article quotes a clinical manager for the Nyanza Reproductive Health Society: "When you teach people how to use condoms, give [them some] to take home, then the message that male circumcision only works together with other HIV prevention strategies is better reinforced."

 

Infant circumcision recommendations debated
Experts agree there is strong evidence that male circumcision protects men in sub-Saharan Africa from heterosexually acquired HIV, but disagree on whether to recommend infant circumcision, reports msnbc.com. A review in the Annals of Family Medicine questions whether the findings from Africa apply in regions with different types of HIV epidemics and notes that no randomised controlled trials have examined the effect of neonatal circumcision on sexually transmitted infections. They conclude it would be inappropriate to recommend routine neonatal male circumcision. But in a review in the Archives of Pediatric and Adolescent Medicine, scientists call on the American Academy of Pediatrics to change its recommendations on infant circumcision to "fully reflect the evidence of long-term health benefits of male circumcision," citing data from the African trials and from supporting observational studies, including studies among men circumcised as infants.

 

Male circumcision research recognized as major medical breakthrough
The Independent (UK) ranks the research confirming that male circumcision reduces men's risk of acquiring HIV infection and other sexually transmitted infections as one of the ten major breakthroughs in medicine of the past decade. (The Independent, 1 December 2009)

 

Why circumcision reduces risk of HIV
Most of the decrease in HIV risk among circumcised men may be explained by the removal of the vulnerable foreskin, suggests research published in PloS Medicine. Being circumcised also reduces a man's risk of acquiring herpes and other conditions that cause genital sores, so researchers analysed data from two randomised trials in Uganda to explore whether male circumcision protects against HIV infection by reducing the incidence of genital ulcer disease (GUD). They used a type of statistical modeling, logistic regression analysis, to estimate and compare the net effect of circumcision on HIV incidence with the direct effects of circumcision on HIV after adjusting for the potentially mediating effects of GUD and recent infection with herpes simplex virus 2. They concluded that the reduction in GUD resulting from male circumcision played only a modest role in the procedure's protective effect against HIV (PloS Medicine, 24 November 2009).

 

Male circumcision brings Swazi men to clinic
Men come to the One Hope Male Clinic in Matsapha, Swaziland, for male circumcision, but 92 percent of them also agree to get tested for HIV, reports PlusNews. Every day about 35 men are circumcised and receive counselling and other HIV prevention services at Swaziland's first clinic specifically for men. With the opening of the clinic in October 2009, the government began an effort to increase the proportion of Swazi men who are circumcised from 21 percent to 80 percent to help curb the spread of HIV (PlusNews, 5 December 2009).

 

Male circumcision and women's risk of HIV
The available data are insufficient to determine whether circumcision of male partners directly reduces women's risk of acquiring HIV, scientists conclude in a review published in the November 2009 issue of The Lancet Infectious Diseases. Their meta-analysis of the data from seven studies showed little evidence of a direct effect. The most rigorous of the studies, a randomised controlled trial, was stopped early for futility after it was unable to recruit enough HIV-serodiscordant couples to detect a protective effect, and the six observational studies produced inconsistent results, likely because of the inherent limitations of this type of study. Women will benefit indirectly from male circumcision as a result of reduced exposure to HIV and some other sexually transmitted infections, and this benefit will increase over time as more men seek additional protection against HIV by becoming circumcised.

 

Zimbabwe's government recommends male circumcision
The government has adopted male circumcision as an additional HIV prevention strategy in Zimbabwe, where almost 14 percent of adults are infected with the virus, The Zimbabwe Telegraph reported on 15 October 2009. Since June 2009, 1,290 men have been circumcised as part of a pilot project that will help guide the development of a strategic plan for expanding male circumcision services from 2010 to 2015. Health officials and their partners emphasised the need to combine male circumcision with other proven prevention methods, because it does not offer complete protection against HIV.

 

Foreskin size linked to HIV risk
Having a larger foreskin was associated with a higher risk of HIV infection in a study conducted among 965 men in Rakai, Uganda. The men participated in a four-year cohort study that included annual HIV testing, and were subsequently enrolled in a randomised trial of male circumcision for HIV prevention, enabling scientists to assess rates of HIV acquisition before circumcision and to measure the surface area of each man's foreskin after the surgery. These findings need to be replicated by other studies, but they bolster the evidence that the foreskin increases vulnerability to HIV, the authors write (AIDS, 23 October 2009 - located under the category, "CONCISE COMMUNICATION").

 

Modelling the impact of male circumcision
One HIV infection could be prevented for every five to 15 men circumcised in settings with high levels of HIV and low rates of male circumcision — at a cost of US $150 to $900 per HIV infection averted over 10 years — experts concluded after reviewing six simulation models estimating the impact of male circumcision on HIV (PLoS Medicine, 8 September 2009). They also found that women benefit indirectly from reduced HIV prevalence among circumcised male partners and that, in high-prevalence settings, male circumcision is not only cost-effective, but also cost-saving. These modelling results guided the development of a decision makers' programme-planning tool, as described in a video from UNAIDS.

 

US officials consider infant circumcision recommendations
The US Centers for Disease Control and Prevention is considering recommending circumcision for baby boys born in the United States to reduce the spread of HIV, The New York Times reported on 23 August 2009. The impact of male circumcision on the US HIV epidemic is not expected to be as dramatic as it was in studies in Africa, where HIV risk was lowered by more than half, because the procedure has not been shown to protect those at greatest risk of HIV infection in the United States: men who have sex with men. But health officials say that all effective HIV prevention measures should be considered and that male circumcision has additional health benefits.

 

Circumcision and HIV risk among MSM
Studies from South Africa and Australia highlight the need to investigate whether male circumcision may be protective against HIV for men who are primarily the insertive partners during anal intercourse with other men. An observational study involving 363 men who have sex with men (MSM) from Soweto—who reported engaging primarily in insertive anal intercourse with their male partners—found that circumcised men were less likely to be HIV positive than uncircumcised men. Circumcised men had a reduced risk of HIV in a prospective study of 1,426 MSM in Australia, but this difference was not statistically significant; further analysis of men who reported a preference for insertive intercourse suggested a protective effect, but the number of men in this subgroup analysis was too small to be conclusive. A randomised trial is needed to confirm these results, which might not be applicable in settings with lower HIV prevalence or less segregation of sex roles among MSM. The findings "show that men who have sex with men should not be excluded from circumcision programs", co-author Dr. Tim Lane said in a press release.

 

South African centre offers free MC with other HIV prevention services
Since January 2008, about 12,000 men have been circumcised at the Bophelo Pele Male Circumcision Centre in Johannesburg's Orange Farm township. The centre is the only health facility in South Africa offering medical male circumcision services for free, PlusNews reports. The article cites the different motivations the centre's clients have for becoming circumcised and describes the experience of 18-year-old Sibusiso Mbele, who received comprehensive male circumcision services, which include counselling about HIV prevention and male circumcision and the offer of HIV testing. "I'll tell my friends it's a good thing to come here," he said (PlusNews, 14 August 2009).

 

Nurses to improve access to male circumcision in Kenya
More men will have access to medical male circumcision services in Kenya as a result of a government decision to allow nurses to be trained to perform the minor surgery, the Nairobi Star reports. Previously, only medical officers and clinical officers were authorized to perform the procedure under the government's voluntary medical male circumcision (VMMC) for HIV prevention programme. This move will help the programme meet the demand for VMMC services and achieve its goal of reducing the number of new HIV infections in the country (Nairobi Star, 4 August 2009).

 

Cost of male circumcision prevents wider use in Uganda
The cost of medical male circumcision prevents it from being more widely adopted for HIV prevention in Uganda, according to a study conducted in four districts of the country by researchers from the Makerere University School of Public Health and the Ministry of Health, with technical support from Family Health International. The Daily Monitor reports that most respondents to the household survey conducted as part of the study thought medical male circumcision should be either free or available at a cost of no more than Shs 5000, or about $US 2.40 (article no longer available ).

 

Ugandan women report no change in sexual satisfaction after partner's circumcision
Fifty-seven percent of women in a study in Rakai, Uganda, reported no changed in sexual satisfaction and 40 percent said they were more satisfied with sex since their partners became circumcised, researchers reported at the 19-22 July International AIDS Society conference in South Africa. In this follow-up to the Rakai randomised trial of male circumcision, only 13 (2 percent) of the 455 women surveyed reported less sexual satisfaction after their partners were circumcised. These results parallel findings among trial participants: 97 percent of the circumcised men reported their sexual satisfaction was the same or better after circumcision (ABC News, 20 July 2009).

 

New York Times examines male circumcision in South Africa
The article compares South Africa, whose government is developing a policy on male circumcision for HIV prevention, to other African countries such as Kenya, where more than 20,000 men were circumcised during the past year, and Botswana, which has trained teams to provide the service in all its public hospitals. Shortages of health care professionals and cultural perceptions of circumcision complicate efforts to reduce HIV infections by improving access to safe and voluntary medical male circumcision services in sub-Saharan Africa (The New York Times, 19 July 2009).

 

Male circumcision and HIV risk among MSM
Preliminary data from an observational study among 378 men who have sex with men (MSM) in South Africa suggest that circumcision may reduce the risk of HIV infection during insertive anal intercourse with male partners, researchers reported at the 19-22 July International AIDS Society conference. Among the men who reported practicing only insertive anal intercourse with their male partners, uncircumcised men were 4.5 times more likely to become infected with HIV than circumcised men were. A randomised controlled trial would be required to confirm these findings, which might not be applicable in settings with lower HIV prevalence or less segregation of sex roles among MSM.

 

Male circumcision provides no direct benefit to women
Circumcision of HIV-infected men did not reduce HIV transmission to their uninfected female sexual partners over two years in a randomised trial among 159 couples in Uganda (The Lancet, 17 July 2009). The trial was undertaken because an earlier observational study had suggested that partners of HIV-positive men were less likely to acquire HIV if the men were circumcised. The results suggest, but do not confirm, that HIV-infected men who resume sex before the wound from a circumcision has healed may be at increased risk of transmitting the virus. "Strict adherence to sexual abstinence during wound healing and consistent condom use thereafter must be strongly promoted," the authors write. Because circumcision offers men such strong protection against HIV, it will benefit women indirectly by reducing their exposure to the virus. A commentary on the study notes that women with circumcised partners are also at decreased risk of several sexually transmitted infections. The authors of both articles support the World Health Organisation/UNAIDS recommendation that HIV testing should be encouraged for all men requesting circumcision, although the procedure should not be refused to HIV-positive men.

 

Zambia plans male circumcision scale-up
The Zambian Ministry of Health is developing a plan to expand male circumcision services to reach 50 percent of men and 80 percent of newborns by 2020, ministry representatives told participants at a 5-6 June meeting of the country's Cabinet Committee of Ministers on HIV and AIDS. The five Cabinet ministers committed (2009, PDF, 32 KB) to scaling up effective HIV prevention measures such as male circumcision. After reviewing the evidence, they agreed that male circumcision could play an important role in curbing AIDS as part of a comprehensive HIV prevention programme (Zambian National AIDS Council press release, 6 June 2009 [PDF, 29 KB]).

 

Zimbabwe opens male circumcision clinics
Zimbabwe's Ministry of Health and Child Welfare will open three male circumcision clinics in the capital city of Harare in June, The ZimDiaspora reports. The ministry is training health workers and promoting male circumcision based on studies showing that the procedure reduces the risk of heterosexually transmitted HIV infection in men by up to 60 percent. An estimated 10 percent of men in Zimbabwe are circumcised.

 

Circumcision does not reduce risk of 3 non-ulcerative STIs
Male circumcision did not reduce the risk of acquiring three sexually transmitted infections (STIs) — those that cause gonorrhoea, chlamydial infection and trichomoniasis — among men in a study in Kenya (Journal of Infectious Diseases, 1 August 2009). The study analysed data on these non-ulcerative STIs among men participating in one of the three clinical trials that confirmed male circumcision's protective effect against HIV infection. Analysis of data on ulcerative STIs in the male circumcision trials conducted in South Africa (Journal of Infectious Diseases, 1 April 2009) and Uganda (New England Journal of Medicine, 26 March 2009) showed that circumcision also offers men partial protection against human papillomavirus and herpes.

 

Botswana campaign could prevent 70,000 HIV cases
Botswana's campaign to circumcise 460,000 men (80 percent of eligible men) by 2012 could prevent almost 70,000 new HIV infections through 2025, estimates a study published in the Journal of the International AIDS Society. This could be achieved at a cost of about US $47 million, for an average cost per HIV infection averted of $689. The study also estimated the impact and cost of male circumcision for HIV prevention under other scenarios. Achieving the 80 percent target by 2015, for example, would avert 60,000 HIV infections through 2025 (The Telegraph, 29 May 2009).

 

Kenyan government reports on progress in Nyanza Province
More than 20,000 men have been circumcised at public health facilities in Kenya's Nyanza Province as part of a national effort to strengthen HIV prevention. The government is offering safe, voluntary male circumcision services at 124 facilities throughout the province, with the goal of circumcising 80 percent of uncircumcised men ages 15 to 49. The provincial director of public health and sanitation noted that a shortage of providers poses challenges as the programme works to train staff and equip facilities so that it can expand to meet the demand for male circumcision services (Capital News, 2 June 2009).

 

What role for male circumcision in the USA?
Male circumcision (MC) substantially reduces female-to-male transmission of HIV and is recommended by UNAIDS and WHO for HIV prevention in countries or areas within countries with high rates of heterosexual HIV transmission and low MC prevalence. But broad MC programmes are unlikely to play a significant role in HIV prevention in the United States of America, the authors of a review article conclude, because the risk of female-to-male transmission is relatively low in the USA. MC also has not been shown to protect against male-to-male transmission of HIV, the predominant mode of transmission in the USA. Noting that MC has other health benefits, such as protection against some sexually transmitted infections, the authors call on US policy-making bodies that are revising recommendations on MC to develop policies and programmes that maximise the benefits while minimising the risks and costs of MC (HIV Therapy, May 2009).

 

Cochrane review confirms effectiveness of male circumcision
A systematic review of the three randomised controlled trials of male circumcision for HIV prevention, published in the influential Cochrane Library, concluded that there is sufficient evidence to recommend male circumcision to prevent heterosexually acquired HIV infection in men. The authors recommend further research "to assess the feasibility, desirability, and cost-effectiveness of implementing the procedure within local contexts."

 

Vaccine trial reports on impact of offering male circumcision
Thirty-eight of the 113 uncircumcised men in an HIV vaccine trial in Soweto, South Africa, took advantage of the male circumcision services offered by the trial, the investigators report in a letter to the editor (A total of 158 men had been enrolled in the trial when it was stopped early because interim results from a study of the same HIV vaccine showed that the product was not effective). An analysis of data on the first 20 men circumcised during the trial revealed that they reported higher levels of HIV risk behavior compared to other participants. This finding that those opting for circumcision may have been at greatest risk of HIV infection, along with the uptake of the service by one-third of all uncircumcised participants, suggests that offering male circumcision services in HIV prevention trials is likely to reduce rates of HIV acquisition. If so, larger study populations will be needed to test effectiveness (Journal of Acquired Immune Deficiency Syndromes, 1 May 2009).

 

Botswana plans to circumcise almost half a million men
Botswana's Ministry of Health plans to circumcise 460,000 men over the next five years to help reduce one of the world's highest HIV infection rates. The ministry says it needs to reach 80 percent of eligible men to realise the public health benefits of male circumcision. About 50 health-care providers, including 27 doctors, have been trained to perform the surgery. Government-sponsored TV and radio ads are encouraging men to seek safe circumcision services at primary and district hospitals with trained providers (Daily Telegraph, 7 May 2009).

 

Circumcision reduces risk of HPV and herpes
Circumcision reduced the risk of two sexually transmitted infections — human papillomavirus (HPV) and herpes simplex virus type 2 (HSV-2) — among men in a study in Uganda, The New York Times reports. Circumcised men had a 25 percent reduced risk of infection with HSV-2 and a 35 percent reduced risk of HPV, confirming similar findings from South Africa. Circumcision did not affect the risk of syphilis among the men in the study.

South Africa considers male circumcision for HIV prevention
The South African government is assessing how to make male circumcision part of its HIV prevention programme, a Department of Health spokesperson said (Online Newshour, 20 March 2009). The Bophelo Pele centre, site of one of three randomised controlled trials that confirmed male circumcision’s protective effect against HIV, is the only facility in South Africa offering the procedure for free with other HIV services. The Kenyan government has developed national guidelines on voluntary male circumcision for HIV prevention and is training providers.



Scientists urge reassessment of policies on male circumcision

Findings from Uganda and South Africa that male circumcision is partially protective against herpes simplex virus type 2 and human papillomavirus should prompt “a major reassessment” of its role in preventing sexually transmitted infections, according to an editorial in the New England Journal of Medicine. These data add to the already compelling arguments for supporting male circumcision in countries with a high prevalence of heterosexually transmitted HIV, the authors write, and other countries should reconsider the potential costs and benefits.


Suriname pilot programme offers free male circumcision
Suriname’s government hopes to provide circumcision services to 100 men and boys in the capital city, Paramaribo, during a three-month pilot programme to help curb sexually transmitted infections, the health minister announced. He noted that male circumcision could also help reduce HIV levels in Suriname, where about 10,000 people are living with HIV (Agence France-Presse, 13 March 2009).


Circumcision may reduce persistent HPV infections
Among those who became infected with the human papillomavirus (HPV) during a US study that followed 285 men for 18 months, circumcised men were more likely than uncircumcised men to have their immune systems clear the virus by the end of the study. Persistent infection with some strains of HPV can cause cancer. Circumcised men in this study were three times more likely to clear any HPV infection and six times more likely to clear an HPV strain linked to cancer.


Male circumcision may offer protection against herpes

Male circumcision reduced the risk of acquiring herpes simplex virus type 2 (HSV-2) by about 55 percent in a South African study (Journal of Infectious Diseases, 1 April 2009). Male circumcision also protected against HIV infections regardless of the HSV-2 status of the study’s participants. An accompanying editorial proposes that a reduction in genital herpes ulcers — rather than a reduction of HSV-2 infections — contributes to the effectiveness of circumcision against HIV.


Male circumcision may offer some protection against HPV
Male circumcision may reduce men’s risk of acquiring human papillomavirus (HPV), according to two studies published in the 1 January 2009 issue of the Journal of Infectious Diseases. In an accompanying commentary, scientists say more evidence is needed to confirm this partially protective effect before male circumcision can be promoted for prevention of HPV, which can cause cervical cancer in women. HPV data from the Kenya and Uganda male circumcision randomised controlled trials might provide that evidence.



What do adult men think about male circumcision for HIV prevention?

New data from Uganda shows most Ugandans support male circumcision to reduce the risk of HIV infection, according to a recently completed but unpublished study conducted by Makerere University and Family Health International. Up to 62 percent of uncircumcised men would consider being circumcised, and up to 79 percent of them would support having their sons circumcised. Support for circumcising sons was even higher among women (up to 95 percent) and circumcised men (98 percent) in this survey of 1,675 people in four districts (Plus News, 3 February 2009).


NEJM examines challenges of introducing male circumcision

The Clearinghouse on Male Circumcision for HIV Prevention is cited as a resource for national programmes in an article describing the challenges facing such programmes as they work to expand access to male circumcision. The authors of the 4 December 2008 issue of The New England Journal of Medicine conclude that such programs “will require strong political backing, adequate funding, and leaders to champion the cause to ensure that it is a safe, low-cost option available throughout Africa.


Combining medical circumcision and manhood initiation shows promise
Combining male circumcision performed by trained doctors and nurses with the traditional rituals of initiation into manhood proved safe, feasible, and acceptable in a study among 78 initiates in East Cape, South Africa (Culture, Health & Sexuality, 1 January 2009). Only seven complications were identified: none were severe, and only one (an infection) required treatment. Almost 90 percent of the men said they were very satisfied with the circumcision, though most participants thought they might face stigma because they had not been traditionally circumcised.



African leaders champion male circumcision

An organization of African leaders, including former African presidents and other influential personalities visiting Mozambique, shared regional experiences in fighting HIV and urged the scale-up of effective HIV prevention strategies. The leaders also asked the government of Mozambique to consider the rapid scale-up of male circumcision a priority under the country’s comprehensive HIV prevention plan. As part of their mandate to mobilize leadership in Africa for HIV prevention, these “Champions for an HIV-free Generation” pointed out the compelling scientific evidence, globally and locally, that male circumcision can greatly reduce HIV infections. (UNAIDS, 12 February, 2009)


Male circumcision a focus of military AIDS conference

More than 150 HIV prevention specialists from the armed forces of 26 African countries discussed male circumcision and other new prevention strategies at a conference in Gaborone, Botswana, 2-6 March 2009. Meeting participants convened to identify and share best practices in HIV prevention among military populations and to help prepare the continent’s armed forces to integrate effective new strategies such as male circumcision for HIV prevention.


New York Times features Clearinghouse

Dispelling myths about male circumcision is one of the purposes of a new Web site created by the World Health Organization, the Joint United Nations Programme on HIV/AIDS, the AIDS Vaccine Advocacy Coalition, and Family Health International, The New York Times (3 March 2009) reported. In its first week, visits to the Clearinghouse on Male Circumcision for HIV Prevention site came from Britain, India, Kenya, Namibia, South Africa, Switzerland, Turkey, and the United States.


Ghana conference supports male circumcision
The National HIV and AIDS Research Conference (NHARCON) in Accra, Ghana, recommended that male circumcision be promoted as an additional strategy for the prevention of heterosexually transmitted HIV infection in men, while not replacing known methods of HIV prevention (GhanaWeb.com, 5 March 2008).



Men 20-30 years old and risk-takers

Complete coverage by male circumcision could reduce HIV prevalence from 12 percent to 6 percent for an average population country in sub-Saharan Africa by 2020, says a new paper by GJ Londish and JM Murray in the Journal of Epidemiology (3 March 2008). Using a mathematical model, they concluded that the highest benefits are achieved mostly by circumcising men between 20 and 30 years of age and those who engage in riskier behaviour.



Sexual function not affected by male circumcision
Adult male circumcision does not adversely affect sexual satisfaction or clinically significant sexual function in men, according to a randomised controlled trial by the Rakai Health Sciences Program, Entebbe, Uganda (About.com, 8 January 2008).

 
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