KENYA: Circumcision demand increases, but guidance crucial
NAIROBI, 23 February 2007 (PlusNews) - Requests for male circumcision have tripled in western Kenya since studies found the procedure reduces the risk of contracting HIV by more than half.
The people of Nyanza Province do not traditionally practice circumcision. But Dr Reuben Okioma, a physician at New Nyanza Provincial District Hospital told PlusNews there had been a three-fold increase in requests for the procedure since the study results were released in December 2006.
"The results of this study are definitely challenging the traditional views of the community," he said, adding that male circumcision was a simple procedure, requiring only a local anaesthetic and a check up three days later.
Hospitals in the region have so far been able to meet the increased demand, but Okioma noted that many more men would request the procedure if the 500 Kenya shillings (US$7) the hospital charged for it were scrapped.
Two clinical trials in Kenya and Uganda were halted in December after an interim review of the data revealed that circumcision reduced a man's risk of acquiring HIV from heterosexual intercourse by about 50 percent. The National Institute of Allergy and Infectious Diseases in the United States, part of the National Institutes of Health, which sponsored the trials, decided it would be unethical to continue with them.
The Kenyan trial recruited almost 3,000 HIV-negative men from Kisumu, in western Kenya, and showed a 53 percent reduction in HIV infections among those who were circumcised. A similar trial in the Rakai District of central Uganda found a reduction in HIV acquisition of 48 percent in the circumcised men.
British medical journal The Lancet on Friday published a final evaluation of data that combined results of these two trials with an earlier trial in South Africa. Researchers concluded that circumcision could actually reduce a man's risk by as much as 65 percent.
Kevin De Cock, director of the World Health Organisation (WHO) HIV/AIDS Department today welcomed the findings, describing them as "a very important contribution to HIV prevention science."
But questions remain about the viability of male circumcision as a national HIV prevention tool.
Dr Kawango Agot, coordinator of the Kenyan trial, told PlusNews that health practitioners were awaiting guidance from the WHO before deciding on a course of action.
The WHO has scheduled an international consultation to discuss the policy, operational and ethical issues surrounding male circumcision for early March.
Agot predicted that more training would be needed before health centres in Kenya could handle a greatly increased demand for male circumcision.
Information about the protective effects of circumcision would also need to be packaged differently for those communities that already practiced it as part of a traditional rite of passage. With the support of local leaders, communities such as the Samburu, in northwestern Kenya, have already been introduced to the "one man, one knife" system.
Okioma believes that traditional surgeons, already accustomed to performing circumcisions, could help meet the demand providing they received training on how to perform the procedure safely.
Agot emphasized the need for people to understand that despite its benefits, circumcision was not a guarantee of protection from HIV. Abstinence and condom use would need to remain the mainstays of AIDS prevention campaigns, she said.
Another report published in The Lancet echoed some of Agot's concerns. "The global experience with access to antiretroviral drugs shows that strong science alone does not result in rapid, widespread rollout," wrote the authors, who went on to list 13 challenges and opportunities relating to implementing male circumcision as a prevention strategy.
Challenges included the need to communicate the relative benefits of the procedure as well as the small but significant risks. Finding sufficient qualified personnel to perform the procedure in the context of the region's already overburdened health systems was cited as another significant challenge.
The authors also recommended that circumcision form just one component of a "combination prevention strategy."
Visit The Lancet
http://www.thelancet.com/journals/lancet
sm/kr/ks
|