Circumcision called key in fighting AIDS

SYDNEY -- A US health specialist urged governments worldwide yesterday to endorse circumcision to slow the spread of HIV, saying men without the procedure have a greater risk of contracting the virus from infected female partners.

Specialists at an AIDS conference in Sydney also warned that HIV infection rates were rising in developing countries among men who have sex with men. The specialists attributed the increase to discrimination and lack of access to health services. The World Health Organization said male circumcision reduces the risk of female-to-male transmission of the disease by about 60 percent. But only 30 percent of men worldwide have had the procedure, mostly in countries where it is common for religious or health reasons.

Robert Bailey, a professor of epidemiology at the University of Illinois, said studies in Africa showed that uncircumcised men were 2.5 times more likely to contract HIV from infected female partners, though many health officials were still unclear about the procedure's benefits.

"If we had a vaccine that was 60 percent protective, we would be very happy and we would be rolling it out as fast as we can," Bailey told reporters at the conference.

"The next step is to get the leaders of countries to actually come up with policy statements endorsing the practice," said Bailey, who has conducted circumcision-related studies in Africa and the United States.

Without local support, international agencies would be unlikely to encourage the procedure, wishing to avoid being seen as imposing foreign cultures or values, he said.

Circumcision, the removal of the foreskin from the penis, has long been suspected of reducing men's susceptibility to HIV infection because the skin cells in the foreskin are especially vulnerable to the virus.

In March, the WHO urged heterosexual men to undergo the procedure because of compelling evidence that it reduces their risk of getting the disease. The WHO cautioned, however, that male circumcision does not offer complete protection against HIV, and said men should still use condoms and take other precautions such as abstinence, delaying the start of sexual activity, and reducing the number of sexual partners.

"Circumcision could drive the epidemic to a declining state toward extinction," Bailey said. "We must make safe, affordable, voluntary circumcision available now."

Bailey also called on international agencies to ramp up funding for circumcision in countries hardest-hit by the epidemic.

Michel Kazatchkine, executive director of the Global fund, a leading international health agency, also called for increased funding.

"I believe that the evidence is overwhelming for the efficacy of circumcision," Kazatchkine told reporters.

"And if countries come to us . . . I see no reason at all why we wouldn't fund that."

Kazatchkine said his organization had not received any requests for funding for circumcision and noted that the WHO's advice on the topic was released in March.

Also at the conference, a leading American AIDS research group said HIV infection rates among men who have sex with men were rising in Africa, Asia, and Latin America, citing figures from UNAIDS.

Studies also show that less than 5 percent of that group have access to HIV-related healthcare, the American Foundation for AIDS Research, or amfAR, said.

"This is a massive failure of the HIV/AIDS response globally, and I think one that needs to be addressed," said Kevin Frost, amfAR's chief executive officer.