Thursday, March 5, 2009

AIDS Prevention 2.0, part 2

Lord knows UNAIDS was slow on the uptake in recognizing the importance of male circumcision as a prevention tool. The long silence on the issue was even more surprising given that its founding leader, Peter Piot, was noting the epidemiological power of circumcision more than 20 years ago, in a 1988 paper he authored for Science. But since the powerful reports of the second and third circumcision trials a couple years back, in Kenya and Uganda, UNAIDS has worked to redress its past oversights. They now have taken another step forward, joining several other partners in a big, fancy new website devoted to disseminating good information on the issue. Check it out at:
I wrote a few days ago about the concept of AIDS Prevention 2.0. The gist was: What things have we overlooked, or deployed badly, in our response to the AIDS epidemic in Africa during the first quarter-century of furious work? By any standard, male circumcision meets my critieria. The original evidence began perking up in 1988, about the time Piot noted it in his Science paper, but the idea languished despite the efforts of people like Robert Bailey, Bertrand Auvert and my co-author for the book project, Daniel Halperin. Only in the past couple of years, after three studies put circumcision's protective effect at more than 60 percent (probably beyond any vaccine imagined), has the conventional wisdom on this issue turned. Yet is it easy for boys or men to get circumcised in the places where HIV is raging in Africa? With few exceptions, it's not. Those wanting the service done safely (or mothers wanting it for their sons) still find it expensive and logistically complex. Waits for appointments can range into the months. Some of those places, such as South Africa and Botswana, also have financial and institutional assets that are the envy of the continent and would make rolling out such programs relatively straightforward.
Let's hope the new website is part of a broader effort to finally move forward on this powerful research, especially given that most Bantu societies already have circumcision as a tradition within their culture. Some activists think circumcising men is not a good idea, or an affront to human rights, but shouldn't the men most at risk for getting HIV, and passing it onto their partners, have a right to the procedure if THEY want it?
(See my story on the issue among Luo in western Kenya:
Please let me know what you think by hitting "Comments" below this post.

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