WHO Recommends Circumcision, Citing HIV Data



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As least three clinical studies have determined beyond any doubt that circumcised men have a reduced risk of becoming infected with HIV. The results are leading the World Health Organization to recommend that young adult men in areas with high rates of HIV should be circumcised — but only if highly trained medical professionals are available.

The agency also warns that it should be clearly explained to the men that circumcision does not completely protect them against infection. The recommendations come with numerous other caveats — which could mean that in most developing countries, circumcision will not be widely available.

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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block. The World Health Organization is now recommending that circumcision be offered to young men in countries that have major AIDS epidemics, including South Africa and Botswana.

The procedure is not usually done in many of those countries. The WHO cautioned that circumcision should be provided along with programs that promote abstinence, monogamy and the use of condoms. NPR's Brenda Wilson reports.

BRENDA WILSON: Though most countries in sub-Saharan African have been affected by HIV, scientists observed that the epidemic is worse where men are not circumcised. In Botswana, for example, it's estimated that more than a third of all adults in the country are infected with HIV. In contrast, in Senegal, a mainly Muslim country where circumcision is part of religious practice, about one-and-a-half percent of adults are infected.

Three clinical studies concluded that circumcision reduces the risk of HIV by as much as 60 percent. Dr. Kevin De Cock, head of WHO's AIDS division, says the findings can't be ignored. Young men who are not infected in countries with high rates of HIV should be circumcised.

Dr. KEVIN DE COCK (World Health Organization): The implications are really quite major because what this represents is the World Health Organization, UNAIDS and the scientific community saying male circumcision is an effective strategy for the prevention of the acquisition of HIV in heterosexual men, and this really needs to be considered as an additional prevention strategy.

WILSON: But if it is to be done, De Cock says, it has to be done right. The procedure should be done by trained health professionals such a physician assistants, nurses, under hygienic conditions. There should be confidentiality, informed consent, no coercion, cultural sensitivity, and offered in a way that carries no new stigma.

De Cock says new resources will be needed so that resources won't be diverted from other AIDS programs. Prevention will still be key.

Dr. DE COCK: Men must be advised that this offers only partial protection. Other prevention measure are required, and we must guard against sort of relaxation of behavioral and preventive measures.

WILSON: There's a biological explanation for why circumcision works. Dr. Ron Gray, professor of reproductive epidemiology at the Johns Hopkins Bloomberg School of Public Health, was in charge of the circumcision study in Uganda.

Dr. RON GRAY (Johns Hopkins Bloomberg School of Public Health): The intact male foreskin is very rich in the cells that are targets for HIV, whereas the outside part of the foreskin is just like ordinary skin. It's covered with a protein called keratin, and the keratin reduces the likelihood of HIV infection.

WILSON: That sensitive skin is exposed during sexual intercourse, heightening the risk of infection. In many countries, removing the foreskin at birth has long been an accepted practice, irrespective of religion, and Gray says that when men in Africa learn that circumcision reduces the chance of infection, many want to be circumcised.

Dr. GRAY: The horse is out of the stable, basically. We either respond to this demand or there is a real risk that surgeries could be performed by people who would not do a safe procedure.

WILSON: WHO is not recommending that men who are HIV infected to be circumcised, since there are suggestions that might be more of a risk for their partners. Studies are underway to determine whether women benefit directly.

By reducing infections in men, the implications are that the whole community, a country in fact, stands to benefit. Millions of new cases of HIV in Africa could be prevented in the next two decades. Brenda Wilson, NPR News. Transcript provided by NPR, Copyright NPR.