A New Way to Protect against HIV?

Making Sense of Male Circumcision for HIV Prevention

By Mitchell Warren

In December 2006, new evidence from clinical trials confirmed male circumcision as the first new biomedical HIV prevention strategy in more than a decade.

This announcement brings exciting opportunities as well as challenges. Based on data from three trials, it appears that male circumcision reduces men’s risk of HIV infection during vaginal sex by roughly 50 percent. Even though the rates of protection may not be as high outside of the controlled environment of a clinical trial, this is still a striking finding.

Adding safe, sterile, voluntary male circumcision to existing HIV prevention programs could avert many infections and save many lives. Circumcision programs could also provide a new way to reach men and adolescent boys who are frequently under-represented in health clinics and HIV prevention programs.

As exciting as these findings are, they are not a silver bullet. We still need all the other proven approaches to HIV prevention. Circumcision will not be universally relevant. In fact, there are many questions which need answers before we can understand whether male circumcision would be a useful HIV prevention strategy in the United States and around the world.

It is absolutely critical to continue to study male circumcision and determine whether it provides any protective benefit to women who are sexual partners of circumcised HIV-positive men and whether it has any protective benefit outside of vaginal sex, particularly in the context of anal sex.

But not having all the answers should not stop us from taking the first big steps now to use these findings to help reduce new infections. Making and resourcing clear plans for filling in these gaps must be given equal priority to rollout based on what we know today.

The benefits of male circumcision can only be realized if male circumcision is offered in programs that contain clear, cultural and context-specific messages and that explain the benefits and limitations of the procedure for men and their sexual partners and the importance of proper wound healing before resuming sexual activity.

Policymakers, programmers and advocates face complex decisions as they seek to translate the research findings into real public health benefits. Decisions about targeting high-risk men should be made with the utmost care. It is essential that circumcision not become falsely viewed as an indicator of HIV-negative serostatus. Programs must develop communications strategies and packages of services that counter this impression and meet the needs of HIV-negative men, HIV-positive men, and especially their partners.

Mitchell Warren is the Executive Director of the AIDS Vaccine Advocacy Coalition

The Caucus for Evidence-Based Prevention is comprised of dozens of diverse organizations.The group monitors HIV prevention programs and policies, reports on HIV prevention-related conference proceedings to a wide audience, and alerts the community when ideology, prejudice, or opinion interferes with evidence-based approaches to reducing the further spread of HIV/AIDS. The article above was published in a newsletter that was distributed May 22, 2007 at the HIV Prevention Leadership Summit in New Orleans.