Monday, October 3, 2011

Circumcision as HIV Prevention in Africa

While a vaccine against HIV is being hotly researched in the United States and other scientifically advanced countries, a major source of HIV prevention in Africa could be as simple as wider implementation of male circumcision. The foreskin is more likely to harbor the HIV virus and transmit it to the bloodstream than is the rest of the penis; currently, circumcisions in Africa have been cited to be 60% effective as a vaccine in men. Because sexual activity is acknowledged as a leading factor in HIV transmission, circumcision has the potential to act as a major preventative barrier amongst a new population of uncircumcised African males.

Given that this procedure has a minimal ground cost, and a high relative effectiveness, it is somewhat surprising that it has yet to be implemented among many African countries. Currently, only 3% of the African sexually active male population is recorded as being circumcised. Leading authorities - including such leaders as the World Health Organization, and the Bill and Melinda Gates Foundation - hope to implement a new program that would have as a goal circumcision of 80% of the 15-49 yr old male population among 14 African countries. Right now, major barriers lie among lack of support from local governments, often due to cultural misconceptions - also, the dilemma that in some areas only physicians (rather than nurses or other medical professionals) would be considered adequately trained enough to perform the procedure.

Right now, as so often seems to be the case, the major solution seems to be education: education of the population regarding the benefits of circumcision, education of medical officials as to the procedure itself, and the recurring education of safe sex practices. Another promising approach is the implementation of new plastic rings (the Shang Ring and PrePex) which, when attached around the foreskin of the penis for a week, cuts off its blood supply and therefore allows for its removal sans suture. The promise of a circumcision that wouldn't require anesthesia is a more appealing option to many sexual active African men, and is therefore expected to increase circumcision rates. Hopefully, this combination of both new and old practice will help to definitely decrease the rate of HIV overall in Africa.

- Elena Higuchi

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