CNS: male circumcision

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HIV prevention: Bridging the gap between research and impact

Shobha Shukla, CNS (Citizen News Service)

[Podcast] We are at an incredible moment in the history of the HIV/AIDS response, which reflected in the vibrancy of the HIV Research for Prevention (HIVR4P 2018) - the only global scientific conference focused on the fast-growing field of biomedical HIV prevention research. Today, the latest research in different areas of biomedical HIV prevention, including vaccines, rings, microbicides and other female-controlled forms of prevention, pre-exposure prophylaxis (PrEP) and long-acting delivery systems, offer the greatest promise of significantly slowing the toll of the disease.

Embarrassment of riches in HIV prevention response?

Dr Mitchell Warren, AVAC

"There are risks and costs to action. But they are far less than the long-range risks of comfortable inaction" - insightful words of former US President JF Kennedy come in mind while listening to respected HIV prevention research advocate, Dr Mitchell Warren, who is the Executive Director of AVAC - Global Advocacy for HIV Prevention. Considerable improvements have happened in HIV responses but a lot remains undone. With research taking place in HIV science, lot of credible evidence is stacking up on not just basic sciences, but also socio-behavioural and operational aspects of rolling out what we know works. Despite loads of evidence, some policies and practices are not evidence-based and impede HIV responses on the ground.

One size does not fit all. Likewise we need an expanded basket of evidence-based interventions and approaches to meet the unique needs and contexts of different key affected populations to prevent HIV. Deliberations on the first day of the 6th National Conference of AIDS Society of India (ASICON 2013), discussed amongst other things, effective strategies for HIV prevention and control.

"Getting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS related deaths," is the theme for World AIDS Days between 2011 and 2015, in line with a new global vision being spearheaded by UNAIDS. Whether all countries, regardless of the size of their epidemic and level of development, will achieve this target is another issue all together. However, countries around the world are trying to work out ways of achieving the UNAIDS vision.

World AIDS Day: 1st December
A new report argues that despite considerable advances in the fight against AIDS, the world is already falling behind pace in the effort to begin ending AIDS. But it doesn't have to be that way - according to the assessment in this report, the top-five critical actions over the coming year could have a tremendous impact. This report, 'Achieving the End: One Year and Counting', released by AVAC: Global Advocacy for HIV Prevention outlines top-five list of critical global priority actions in 2013.

Modeling based on a timeline where 80 percent coverage of Voluntary Medical Male Circumcision (VMMC) of men age 15-49 is achieved by 2015 suggests that more than 20 percent of new HIV infections would be averted by 2025, with financial savings of an estimated USD 16.6 billion in future medical costs, said Cindra Feuer, Communications and Policy Advisor, AVAC - Global Advocacy for HIV Prevention at AIDS Vaccine 2012.

[Sign the petition] The term 'male circumcision' implies that female circumcision also exists. Females who are subjected to genital cutting are said to have undergone female genital mutilation (FGM) or cutting (and not circumcision). Responsible professionals no longer use the term female circumcision. That is why the word 'male' is redundant. All circumcision is performed on males only. Growing number of activists at the XIX International AIDS Conference (AIDS 2012) are signing a petition for replacing the term 'male circumcision' with 'circumcision'. The petition will be submitted to the World Health Organization (WHO) and the Joint United Nations programme on HIV/AIDS (UNAIDS) asking them to replace the term 'male circumcision' with 'circumcision' and treat women with respect, said Jamie Uhrig, who also manages HIV Information for Myanmar (HIM).

As world's largest AIDS conference (XIX International AIDS Conference) on the theme of 'turning the tide together' is about to open in US next month, CNS decided to share one of its interviews with noted expert on voluntary medical male circumcision and its role in HIV prevention. Voluntary medical male circumcision protects against HIV. "There are over 40 observational studies among heterosexual men, which show that circumcised men have about a 60% reduced risk of HIV compared to uncircumcised men. There were then three randomised controlled trials conducted in Sub Saharan Africa that showed circumcised men were at 60% less risk of HIV than uncircumcised men. All these three trials were stopped by independent Data Safety Monitoring Boards as the effect was so strong and it was thought unethical to not offer circumcision to men in the control arm" said Dr Helen Weiss, Reader in Epidemiology and International Health, The London School of Hygiene and Tropical Medicine (LSHTM). Dr Weiss works mainly on HIV and biomedical behavioural prevention strategies focussing mainly on sub-Saharan Africa and spoke to CNS at AIDS Vaccine 2011.