Male circumcision is being promoted as the next big thing in HIV prevention at the XVII International AIDS Conference, but India is not considering making it a part of its prevention programme because of religious and cultural sensibilities.
Failure of large-scale vaccine and microbicide trials has led to a discernable shift away from technological fixes as a prevention tool to promote proven strategies. “Problems such as the persistence of HIV in latent reservoirs presents a major challenge to the ultimate goal of eradicating HIV from human body,” said Dr Pedro Cahn, president of the International AIDS Society. “While researchers strive to answer this and other key scientific questions, we cannot afford to squander the prevention and treatment knowledge that already exists today.”
Circumcision is the surgical removal of the sleeve of skin and mucosal tissue — commonly called the foreskin — that covers the head (glans) of the penis. Studies show it reduces HIV infection by as much as 60 per cent, apart from lowering risk of sexually-transmitted diseases, urinary tract infections, cancer of the penis and cervical cancer in partners. “The benefits are many, and, in the case of HIV alone, one infection is stopped for every 5-15 men circumcised,” says Nicolai Lohse, a research officer with UNAIDS.
NACO director-general Sujatha Rao, however, says India has no plans to make circumcision a part of its national HIV prevention strategies. “We have to keep religious and cultural sensibilities in mind before introducing changes in prevention strategies. Preventive vaccine and microbicide trials have had disappointing results but drug development is a difficult and time-consuming process that takes years before showing results. The world hasn’t given up hope. Even if the world had a preventive vaccine, HIV prevention would continue to require a combination of strategies such as promoting behavioural change and strategies such as awareness programmes, consistent condom promotion and harm education services to injecting drug users, among others,” says Rao.