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PEPFAR to Fund Male Circumcision Programs as Prevention Strategy in Some African Countries

The President’s Emergency Plan for AIDS Relief (PEPFAR) has committed to funding programs promoting male circumcision as part of its overall strategy to prevent HIV infection. United States Health and Human Services Secretary, Mike Leavitt, announced this decision on August 17th in Johannesburg, South Africa while on a ten-day tour to observe the progress of U.S.-funded malaria- and HIV- prevention programs in Mozambique, Rwanda, Tanzania, and South Africa.1  While initial PEPFAR funding for male circumcision programs will only be in the hundreds of thousands of dollars, this amount will increase over time as this strategy is likely to be integrated as a significant element of the overall program.2

Earlier this year, U.S. Global AIDS Coordinator Ambassador Mark Dybul endorsed guidelines on male circumcision as a means of lowering the risk of HIV infection put out by the World Health Organization (WHO) and the Joint United Nations Programmes on HIV/AIDS (UNAIDS).3  These guidelines were based primarily on the findings of studies conducted in Orange Farm, South Africa; Kisumu, Kenya; and Rakai District, Uganda which indicated a 50–60 percent reduction in risk of heterosexually acquired HIV in circumcised males. WHO/UNAIDS recommend integrating circumcision of HIV-negative males as a complement to existing strategies, not as a sole means of prevention. 4

The Pan American Health Organization (PAHO) has also expressed hope for the viability of male circumcision to supplement currently implemented strategies of HIV prevention, it is not yet poised to launch such a program. PAHO recently announced plans to conduct its own expert consultation in the later half of this year to determine whether or not to promote a large-scale campaign for male circumcision in Latin America and the Caribbean or whether it is necessary to conduct more comprehensive studies.5

International health experts, organizations, and donors are increasingly hopeful about the potential impact that male circumcision can have on prevention efforts, yet they remain cautious about the extent of that impact. Male circumcision offers partial protection to the circumcised man who engages in vaginal sex, but does not offer any protection for his sexual partner. 

In addition, there are a number of potential obstacles that could undermine the overall effectiveness and viability of male circumcision as a widespread prevention option. To date, there have not been any studies conducted regarding how male circumcision impacts the risk of HIV infection from anal sex, either for a circumcised man or his sexual partner.  There has also been little investigation into the impact of conducting the surgical procedure on adult men as opposed to infants as has been done traditionally. And, due to the cosmetic changes, as well as change in the level of sensitivity and sexual pleasure, it is anticipated that some men may be apprehensive about opting for the procedure.  Further attention to all of these matters is required in order to more adequately assess the appropriateness of promoting male circumcision among HIV-negative men.

References

  1.   “PEPFAR To Begin Providing Funds for Male Circumcision Programs in Some African Countries, Officials Say,” Kaiser Daily HIV/AIDS Report, 20 August 2007,  accessed on 20 August  2007, <http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=46963>.
  2.   Craig Timberg, “Anti-AIDS Program To Fund Circumcision U.S. Initiative Targets African Men,” Washington Post 20 August 2007, A10.
  3. Male Circumcision Services for PEPFAR Funding, Embassy of the United States- Tanzania (29 March 2007), accessed on 22 August 2007, <http://tanzania.usembassy.gov/pr_03292007.html>.
  4.    New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications, (Montreaux: WHO/UNAIDS, 2007), 3.   
  5. “New Evidence for Prevention through Male Circumcision,” HIV News 15 (Washington, DC: PAHO, July 2007), 1.

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