Photoshare

[MEXICO CITY] In addition to decreasing the transmission of HIV, circumcision is cost effective and can reduce the risk of human papillomavirus (HPV) infection, researchers have announced.

Researchers presented a mathematical model at the International AIDS Conference in Mexico City last week (6 August) that showed that male circumcision programmes are economically feasible in Sub-Saharan Africa.

While they may cost more than US$900 million dollars to initiate, the budget for antiretroviral therapies would be cut considerably with the reduction in new infections.

"Calculations suggest that, over a 20-year period, two billion dollars would be saved," said Bertran Auvert, professor of public health at France's national biomedical institute INSERM.

Auvert also announced that HPV infection can be cut by around 40 per cent in men, as well as circumcision reducing HIV infections by 60 per cent.

"Circumcision could therefore be an indirect way of limiting the risk of genital cancers caused by HPV in women," said Auvert.

According to Alvaro Bermejo, executive director of the International HIV/AIDS Alliance, studies in South Africa show a high level of acceptance of male circumcision. "We've seen high uptake and there are lengthy waiting lists right now," he said.

But expansion of the practice in Africa has proved slow. "If it were a traditional biomedical product, like a pill, I think we would see roll-out much more quickly," said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition. "But you are dealing with a deeply cultural and social issue."

For example, the elders of the Luo tribe, a large community in Kenya, have refused to endorse male circumcision as it is against their culture and they are not convinced it will decrease the rate of new infections.

And in Indonesia, Christians have been reluctant to get circumcised because the practice is associated with the coming of age for young Muslim boys, explained Karen Houston Smith, deputy director of Family Health International, Indonesia. "They feel this casts some doubt on the validity of their Christianity."

Bermejo stressed that dialogue and information will be essential for any global strategies to roll out male circumcision.

And the messages need to be clear. "We need to be sure we are not putting women at risk. We need to be sure that men who do get circumcised don't think that they can now stop using condoms" said Warren.

"But that doesn't mean we should not be scaling up in a strategic and smart fashion that is addressing all of these other factors."