In-depth: At the Cutting edge - male circumcision and HIV

SENEGAL: Circumcision message could confuse gay community

Photo: IRIN
Homosexuality remains a taboo subject in the country
Dakar, 8 August 2007 (IRIN) - Experts are warning Senegalese men who have sex with men not to get caught up in the hype about male circumcision after recent research indicated that the procedure could offer some protection against HIV, and are urging them to keep using other means of protection.

In 2006, the results of three studies, one each in South Africa, Kenya and Uganda, showed that the risk of HIV infection was up to 60 percent lower among circumcised men. However, these studies were specific to heterosexual interaction.

The HIV prevalence among men who have sex with men (MSM) in Senegal is an estimated 21.5 percent, according to the French Institute for Applied Medicine and Epidemiology (IMEA), compared to a national average of 0.7 percent. AIDS campaigners worry that the preliminary data on male circumcision could lead to reckless sex and an even higher HIV prevalence.

Circumcision is almost universal among Senegalese men.

In a 2003 study on stigma, violence and HIV among MSM by Dr Cheikh Niang of the Cheikh Anta Diop University in Dakar, the Senegalese capital, only 23 percent of MSM said they had used a condom during their last sexual encounter.

"Within Senegal's cultural context ... where homosexuality remains a taboo subject, we do not want to encourage people to hide behind the idea that circumcision completely prevents the transmission of HIV," a member of an MSM association, who requested not to be named, told IRIN/PlusNews.

He said the hidden nature of homosexuality in Senegal meant gay men often married or had girlfriends in order to fit into society, but still engaged in clandestine homosexual activity, putting many people at risk. In the IMEA study, 94 percent of participants also had sexual relations with women.

The results of observational research, published in the Journal of Infectious Diseases in 1993, suggested that the risk of circumcised homosexuals contracting HIV during sex could be halved; another study in 2005 in the United States reached the same conclusion.

However, neither of these was as extensive as the three African studies that prompted the United Nations World Health Organization (WHO) to recommend male circumcision as a tool in the fight against the AIDS pandemic.

"We know nothing; [these] are observational studies; therefore, they prove nothing," Bertran Auvert, one of the authors of the South African study, said in an interview published on a gay rights website called 'The Warning'. "We can merely suppose that there is a certain level of protection."

The only thing the medical profession is sure of is that MSM run a considerable risk of HIV infection, especially since intercourse is often unprotected.

Vigilance in prevention must be maintained

"Prevention must always be targeted, so that the message can be better understood and conveyed in the correct manner. When I hear all the media hype about circumcision, I get scared that people will get confused," the MSM association member noted.

"We have not yet worked on a specific statement to raise awareness, even if it were merely to tell people that condoms are the only thing that can offer protection."

Khoudia Sow, the HIV/AIDS focal point for the WHO in Senegal, commented that "It is certainly not a question of revising all our prevention techniques; circumcision could play a part in the range of existing measures, but in no instance would it substitute them."

The university's Dr Niang agreed. "MSM have to deal with many situations where they are excluded. Their lives are unstable, they are rejected by society and the health services, they do not have much control over negotiating their sexual relations, and drug use can also be an issue," he said. "These factors increase the risk of HIV infection a great deal more than whether or not they are circumcised."

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