MALE CIRCUMCISION IS NOT A SUBSTITUTE FOR RESPONSIBLE SEXUAL BEHAVIOUR.

Since the 1990s studies on whether male circumcision can be used as a preventive measure against HIV continue to be at great variance. Caldwell and Caldwell (1994) used geographical distribution evidence to argue that the association between lack of circumcision and a high level of HIV infection in Africa is credible.

Others like De Vincenzi and Mertens (1994) opine that the evidence for a relationship based on miniature surveys, is unconvincing and hence not conclusive enough to qualify male circumcision as an effective intervention. Siegfried et al (2005) point at an association between lack of circumcision and increased risk of HIV; but they conclude that the quality of evidence is insufficient to warrant implementation of male circumcision as a public health measure. In other words, they opine that there could be other factors besides lack of circumcision that could explain the higher rate of HIV infection in the males who are traditionally not circumcised.

In 2006, a press release from the American National Institutes of Health (NIS) cited Kenya and Uganda as study cases. The studies showed that about 56 circumcisions were needed to prevent one HIV infection. It must also be understood that in this particular context an association between circumcision and HIV infection did not prove a cause and effect relationship. There were definitely confounding variables. Moreover, the studies failed to avoid selection bias and expectation bias. From the foregoing, I am yet to come across a study that conclusively points at male circumcision as a preventive measure against HIV infection.

Given the existing information gaps, it would be naïve for anyone to appear to be billing male circumcision as public health policy. Such judgments are extremely dangerous. Unfortunately, the public continues to be inundated with popular reports from both the public health practitioners as well as from some sections of the media indicating that the likelihood of one contracting HIV after undergoing circumcision is minimal. They haughtily opine that it (male circumcision) reduces HIV infection by 60%. This may be so. But is a more than forty percent chance of infection (after a risky sexual behavior) minimal by any standards?

Such miscommunication is likely to have far reaching ramifications in the fight against the AIDS scourge in this country. Already reports are emerging that men who have recently undergone circumcision (in arrears where male circumcision is not a tradition) are eagerly waiting for the forty days in the wilderness to lapse (recuperation) before they rush into sexual frenzy. This is because they have inadvertently been made to believe that male circumcision is a substitute for other known prophylactic measures. Such misinformation will obviously contribute to the high rate of HIV infection in the regions where male circumcision is being billed as a preventive measure to HIV.

In my opinion behavioral factors are far more important in preventing new infections than the presence or absence of a foreskin. It is therefore incumbent upon the public health practitioners as well as the mainstream media to come up with an effective communication tool that will completely eradicate the myths surrounding male circumcision. Those being circumcised must be told in no uncertain terms that male circumcision is just but part of a comprehensive prevention package, which includes among other things; correct and consistent use of male or female condoms, faithfulness among married couples, reduction in the number of sexual partners, delaying the onset of sexual relations and HIV testing and counseling.

TOME FRANCIS,
BUMULA.
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