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Preventing HIV Infection
Strategic Guidance
on HIV/AIDS Prevention
Purpose of the Guidance Note
Strategic Orientation for UNFPA Action
Integrating HIV/AIDS Issues into the Country Programming Process
Country Situations
Core Support
Creating an Enabling Environment for HIV Prevention
Advances in New Technologies and Issues
The Way Forward
ICPD+5 Goals
Regional HIV/AIDS Statistics
Advances in New Technologies and Issues

Microbicides for HIV Prevention
Male Circumcision

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Male Circumcision

According to epidemiological and ecological studies, male circumcision is associated with a reduced risk of acquiring sexually transmitted HIV infection.

On the basis of such studies controversy has emerged over the call for circumcision to become part of a public health HIV risk-reduction strategy.

Proponents of circumcision argue that there is mounting evidence to correlate male circumcision with reduced rates of HIV infection and other STIs, including chancroid, syphilis and genital herpes and that the practice should therefore be encouraged as part of an HIV-prevention programme.

The evidence consists of about 40 observational studies that uncircumcised men have about a two- to eight-fold increased risk for HIV infection.

Other scientists urge caution indicating that no randomized clinical trials exist to support the assertion that male circumcision reduces the risk of HIV infection, and that as yet unidentified confounder variables (including differences in religion, sexual practices and hygiene) could be responsible for the correlation.

Moreover, even if causality could be proved, male circumcision might be contraindicated for a variety of reasons. Male circumcision is a procedure that can potentially lead to infection, excessive bleeding, dismemberment, and even transmission of HIV through non-sterile equipment.

Even if the procedure were completely benign, support for male circumcision could lead to the erroneous assumption that circumcision was sufficient to completely prevent HIV infection, which could result in an increase in risk-taking behaviour.

The effect of male circumcision on condom use is not known, but there is concern that condom use would be lessened if male circumcision were presented as a means of reducing the risk of STIs.

With no definitive cure for HIV/AIDS, and no vaccine yet available, it is important that any potential means of reducing the risk of HIV infection be explored. However, circumcised men are still at risk and as such proven effective measures such as condom promotion and use, behaviour change and STI prevention management must still be the main stay of preventive efforts while awaiting for more scientific evidence that validates the claims that male circumcision does reduce the risk of acquiring HIV infection.

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