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Slow progress in expansion of voluntary circumcision coverage
Gus Cairns, 2013-03-07 06:50:00
Progress towards greater coverage of voluntary male circumcision (MC) in Africa remains slow, and is due as much to men’s fear of the operation as it is to resource constraints, despite low and decreasing rates of complications, the 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013) heard on Monday.
Increased circumcision rates are already leading to lower HIV incidence in both men and women in areas where coverage is high, and also to lower rates of other sexually transmitted infections (STIs), human papillomavirus (HPV) and genital ulcer disease in female partners of circumcised men.
But because of the cost of scale-up, cost savings are unlikely to be seen for 10-15 years, despite lower treatment costs for HIV and STIs. Higher cost savings would be achieved over the long run by circumcising infants as well as adults and adolescents, but this will depend on parents seeing a benefit in it.
Dr Connie Celum of the University of Washington in Seattle introduced a poster discussion session on circumcision. She noted that in a high-coverage area such as Rakai in Uganda, where one of the three randomised controlled trials (RCTs) that showed male circumcision significantly reduced HIV transmission was conducted, HIV incidence had already halved in the male population (from 1.2% a year to 0.6%).
However only three countries in Africa – Kenya, South Africa and Zambia – had reached even 20 to 30% of their target for uptake of MC, and only four more (Tanzania, Swaziland, Botswana and Zimbabwe) had achieved even 10,000 by April 2011. This was partly due to resource limitations and the training up of staff, but also to the reluctance of some men to be circumcised.
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