Is Male Circumcision as Good as the HIV Vaccine We‘Ve Been Waiting For?

Abstract

What would the reaction of the international public health community have been if a year ago scientists had announced the discovery of a vaccine or chemical gel that, in three separate clinical trials, had reduced the risk of heterosexual HIV infection in men by at least 60%? Considering that even with increasing access to antiretroviral therapy AIDS continues to be a huge killer -every day over 2,000 men become infected with HIV in sub-Saharan Africa alone [1], which eventually also results in millions of new cases in their partners and children -would not such an announcement have surely sparked a massive surge of excitement and renewed investment in HIV prevention?In fact, in December 2006 officials from the US NIH did announce the discovery of an intervention at least as effective, for heterosexual transmission, as the long hoped for AIDS vaccine. However, unlike many previous breakthroughs in medicine, this time the intervention was not discovered by a team of scientists toiling in academic or government laboratories. Rather, some two decades ago anthropologists, demographers and epidemiologists initially

Reassessing HIV Prevention

“…The population-level effect of widespread MC is observed in west Africa, where HIV has been present for many decades, yet prevalence remains relatively low (1, 7 19, 20). All three recent RCTs of MC in Africa were stopped early for ethical reasons when initial findings demonstrated at least 60% reduction in HIV risk (19,20). The population-level impact, taking into account "herd immunity," could be even greater if a large proportion of men become circumcised (19,20).…”

“…All three recent RCTs of MC in Africa were stopped early for ethical reasons when initial findings demonstrated at least 60% reduction in HIV risk (19,20). The population-level impact, taking into account "herd immunity," could be even greater if a large proportion of men become circumcised (19,20). Unlike most other interventions, MC is a one-time procedure that confers lifelong protection.…”

“…In Swaziland, men almost rioted because circumcision services were not available (20). Studies suggest that up to 80% in high HIV-prevalence countries like Botswana and Swaziland would seek MC if it were safe and inexpensive (22).…”

“…MC must be combined with behavior change, especially promotion of partner reduction and consistent condom use (1, 2, 19). Over time MC, which has been called a "surgical vaccine," would probably protect more women, albeit indirectly, than nearly any other achievable HIV prevention strategy (19)(20)(21).…”

Male Circumcision is Not the HIV ‘Vaccine’ We Have Been Waiting For!

“…A recent commentary claims that circumcision is "at least as good as the HIV vaccine we have been waiting for, praying for and hoping to see in our lifetimes" [1]. Thousands of African men now line up to get circumcised in the mistaken belief that it will save them from HIV, as some developing nations -lacking even rudimentary medical care and clean drinking waterrush to implement mass circumcision programs with encouragement and millions of pledged dollars from the US government [2,102,103].…”