Prevention
By Frankie Edozien
TORONTO -- As delegates to the XVI International AIDS Conference, walked the halls and talked of HIV prevention strategies, conversations invariably led to the recent study in Orange Farm, South Africa that found that circumcision had an astounding 61 percent chance of preventing female-to-male HIV infection. One of the biggest donors to HIV/AIDS research, Melinda Gates, even touted circumcision during the opening ceremonies fueling the ongoing debate on its efficacy That adult male circumcision could be a preventative procedure, permeated so many conversations that it was surprising to some that there was only one panel discussion on the issue among the myriads presented during the conference, held Aug. 13-18. Delegates reported that in Botswana, many men were lining up to get circumcised if it meant protection from HIV. Kawango Agot, a researcher from Kenya, presented findings that concluded circumcision has “shown some protective effects for women and if it’s not helpful for women, it’s not helpful at all.” She conducted two studies of men who used government facilities and were not in a controlled trial. “Forty-seven percent chose circumcision because of protection against sexually transmitted infections.” Her colleagues on the podium seemed to agree that the power of circumcision as a prevention tool is a forgone conclusion. While international organizations are waiting for the results of two more studies before officially beginning to praise its benefits, Agot said there are 13 more studies going on in nine African nations. A study by Dr. Robert Bailey of the University of Illinois, Chicago is expected to be completed by 2007. His study in Kisumu, Kenya, began with nearly 5,000 people, but now has 2,784 subjects. Dr. Douglas Schaffer of the Walter Reed Army Institute of Research said his study of residents in rural Kenya, where 77 percent never used condoms, showed that the procedure “offers a degree of prevention for men in the Rift Valley.” Kyeen Mesesan, graduate student at the Yale School of Medicine, presented findings from a study in Soweto, South Africa, and concluded that if the male circumcision program was continued, 32,000 new infections could be prevented in 20 years. “Circumcision is already having a tangible effect on the epidemic there,” she said but warned that “if risk behavior continued [among the newly circumcised] the benefit of the program could be diminished.” Dr. James Kahn, professor, Division of Clinical Epidemiology, Institute for Health Policy Studies at the University of California, worked on the much-talked about South African random control trial that concluded that 61-percent preventive efficacy in adult male circumcision represents a cost-effective tool in prevention methods. At a cost of $55 per adult male, the cost-saving in HIV treatment could be $8,000 or more. Four of the five experts who spoke to delegates at the conference were white researchers from the United States. A point not lost on the multicultural delegates. I’m happy to see your face up on the panel,” Nesha Haniff, a Jamaican researcher, said to Agot. “How can you roll out a plan that tells us to say to black men what to do with their penises from research that’s from a predominately white and western sector. It’s impossible,” she said. Haniff said later: “It is my great frustration that the lead scientists on almost all these projects are western, white and almost always predominately male. Our culture and perceptions and realities are constantly being left out and structured like a purely logical scientific problem. Many questions were left unanswered. Details on the science itself on why circumcision is preventive were sketchy. “I want to be able to explain why it works. They haven’t told us that. Just that it works,” Haniff said. Some social scientists lamented the fact the studies failed to consider the cultural implications of asking black African men to consider circumcision. Others said scientists were confusing the issue by suggesting condom use instead of the surgical procedure. “We are saying that if the studies conclude that it is beneficial, it has to be incorporated into the whole spectrum of prevention strategies, including condom use, abstinence, faithfulness, other risk reductions, needle exchange and everything else,” Agot said. Frankie Edozien is a reporter for the New York Post.