More comments on male circumcision trials
I posted this on the Princeton AIDS blog, but thought I’d reference the post here.
Yesterday, the NIH announced that it was suspending male circumcision trials. Because the trials were so successful, the NIH determined it was unethical to continue with additional rounds of treatment and control groups.
The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.
Amy Patterson in her recent book on AIDS in Africa raises an interesting issue about male circumcision. She suggests that male circumcision represents a search for “technical solutions” and a broader failure of policymakers to address the political and economic structures that contribute to HIV vulnerability” (11).
Specifically, she is referring to the recurrent patterns of gender inequality that expose women to unequal power relations vis a vis male sexual partners, from the broad system that makes women economically vulnerable and dependent on men to coerced sex and a lack of willingness by men to use condoms.
While I agree with her broader concerns about gender inequality, it is pretty clear that both patterns of long-term concurrent sexual partners, low condom use, and systemic gender inequality are not going to be easy to change in the short-run. While women may enter into unequal sexual relations in years to come, if they do so with circumcised men, at least their risk of exposure to HIV should go down significantly. That, in my view, is a very good thing.
Filed under: Epidemiology
[…] Dr. Wilson’s view is that the circumcision in African societies has historically been practiced by certain groups and has specific cultural connotations and is associated with rites of passage. It is therefore likely to be a much more complex and difficult policy to implement without incurring a cultural backlash or other unanticipated consequences. We’ve blogged about it before, but my guess is that if donors can work out a way to implement a circumcision program that is culturally appropriate and that people want, then this may well be worth trying in addition to other educational and behavior change programs. In addition, not instead of. […]