While its correlation with HIV has been debated for long, the World Health Organisation (WHO) and UNAIDS today recommended that male circumcision be implemented in HIV intervention programmes globally.“Based on compelling evidence presented, male circumcision should now be recognised as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men,” the announcement said. It suggested that countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men and that “scaling up male circumcision in such countries will result in immediate benefit to individuals”.“Being able to recommend an additional HIV prevention method is a significant step towards getting ahead of this epidemic,” said Catherine Hankins, associate director, Department of Policy, Evidence and Partnerships at UNAIDS. “However, we must be clear: male circumcision does not provide complete protection against HIV. Men and women who consider male circumcision as an HIV preventive method must continue to use other forms of protection such as male and female condoms, delaying sexual debut and reducing the number of sexual partners,” said Hankins.The international consultation said there is now strong evidence from randomised controlled trials undertaken in Kenya, Uganda and South Africa that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 per cent. Currently, an estimated 665 million men, or 30 per cent of men, are estimated to be circumcised.The consultation recognised that since male circumcision has strong cultural connotations the services had to be delivered in a manner that is culturally sensitive and that minimises any stigma associated with the status. Countries should ensure that male circumcision is provided with full adherence to medical ethics and human rights principles, including informed consent, confidentiality, and absence of coercion. However, India has responded cautiously. “There is scientific evidence to prove that circumcision has proved effective in HIV prevention. However, to follow it in India we will have to deal with the matter very sensitively. We have our own connotations and set of problems here and we will have to take this measure in a very careful manner. Although we are not bound by the WHO guidelines, this measure has proved to be effective,” says K Sujatha Rao, director of the National AIDS Control Programme.
