Male Circumcision: Addressing Implementation Challenges and Demonstrating Impact  TUAC03

Oral Abstract Session Back
Venue: SR 6 (450)
Interpretation: None
Time: 14:30 - 16:00, 05.08.2008
Code: TUAC03
Co-Chairs: Maria Imilse Arrue, Cuba
Kim Dickson, Switzerland

Presentations in this session:

Carmen Murguia, Peru

Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when?
Presented by Richard White, United Kingdom
R. White1, J. Glynn1, K. Orroth1, E. Freeman1, R. Bakker2, H. Weiss1, L. Kumaranayake1, D. Habbema2, A. Buvé3, R. Hayes1
1London School of Hygiene and Tropical Medicine, EPH, London, United Kingdom, 2Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 3Institute of Tropical Medicine, Antwerp, Belgium

Challenges in developing models to estimate the impact of male circumcision on the HIV epidemic
Presented by Nicolai Lohse, Switzerland
N. Lohse1, C. Hankins1, J. Hargrove2, B. Williams3, WHO/UNAIDS Male Circumcision Working Group
1Joint United Nations Programme on HIV/AIDS (UNAIDS), Evidence, Monitoring, and Policy, Geneva, Switzerland, 2South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa, 3World Health Organization (WHO), Geneva, Switzerland

Using male "traditional circumcision" as novel approaches for HIV prevention messages: experiences & opportunities from the Southern Rift Valley of Kenya
Presented by Fred Sawe, Kenya
F. Sawe1, W. Obwiri1, W. Dalal2, D. Kigwenay3, A. Kemei4, C. Kilel1, I. Kiptoo1, T. Hamm2, N. Michael2, D. Shaffer5
1Kenya Medical Research Institute, Kericho, Kenya, 2United States Military HIV Research Program, Rockville, United States, 3Kenya Ministry of Health, Kilgoris, Kenya, 4Kenya Ministry of Health, Kericho, Kenya, 5United States Military HIV Research Program, Kericho, Kenya

Adult male circumcision: effects on sexual function and sexual satisfaction
Presented by John N. Krieger, United States
J.N. Krieger1, S.D. Mehta2, R.C. Bailey2, K. Agot3, J.O. Ndinya-Achola4, C. Parker5, N. Pugh5, G.A. Magoha6, S. Moses7
1University of Washington, Urology, Seattle, United States, 2University of Illinois Chicago School of Public Health, Epidemiology, Chicago, United States, 3UNIM Project, Kisumu, Kenya, 4University of Nairobi, Medical Microbiology, Nairobi, Kenya, 5RTI International, Research Triangle Park, United States, 6University of Nairobi, Surgery, Nairobi, Kenya, 7University of Manitoba, Community Health Sciences and Medicine, Winnipeg, Canada

Estimating the uptake of safe and free male circumcision in a South African community
Presented by Bertran Auvert, France
D. Taljaard1, D. Rech1, S. Doyle1, D. Lewis2, C. Legeai3, P. Lissouba3, F. Lert3, B. Auvert4
1Progressus, Johannesburg, South Africa, 2National Institute for Communicable Diseases, Johannesburg, South Africa, 3INSERM U687, Villejuif, France, 4INSERM U687, Assistance Publique-Hôpitaux de Paris, University Versailles Saint-Quentin, Villejuif, Boulogne, Versailles, France

Rapporteur reports

Track C report by Gaston Djomand

Diverse mathematical models to estimate the impact of male circumcision (MC)  on the HIV epidemic  produced consistently similar results.  These models show in detail how cost effectiveness of MC may vary by age at circumcision. MC seemed to offer the maximum benefit to men aged 20-34years with no alteration by risk compensation in newly circumcised men. Ongoing surveillance however is needed to elucidate remaining uncertainties and assess uptake of circumcision in countries with low MC prevalence and high HIV prevalence.

A study conducted in rural Kenya documented  successful opportunities to provide HIV prevention , sexual and reproductive health,  and gender messages  to young at risk males about to undergo “rite of passage” traditional\tribal circumcision.  The effects of MC on sexual function and pleasure emerged as an important question and a case control conducted among 2,784 participants study indicated no difference in sexual function and pleasure.  Despite recommendations to roll-out MC, it is essential to assess the uptake of safe MC.  In South Africa, uptake data were encouraging , however, self report of MC status was not accurate. It is of utmost importance to improve knowledge of what MC is and not rely on self reported MC status.

Leadership report by Nithya Krishnan

The enthusiastic presentations and panel discussion on male circumcision drew hundreds of delegates. Three randomized control trials have confirmed that male circumcision is efficacious in controlling the contracting HIV/AIDS. All of the presentations were based on this and other evidence that shows that male circumcision is beneficial to reducing HIV/AIDS contraction and transmission from females to males. All of the presenters vehemently agreed that male circumcision should be an addition to intervention and strategies as a preventative method.

Richard White presented the prioritization of who should be the target population and made suggestions for the timeline of when this population should be circumcised. The basis of his presentation was that circumcision has been proven to reduce susceptibility to HIV acquisition in HIV negative men, and should be implemented in policy with specific guidelines. He concluded that where feasible, circumcision should be promoted both in neonates and young adult men up to the age of 35 years.

The presenters were in unanimous favor of this policy implication because it could dramatically reduce HIV incidence in heavily affected countries. Estimating the potential impact is essential to rational decision making as the circumcision has been shown to be cost-effective.

Frederick Sawe of the Kenya National Medical Institute discussed the incorporation of traditionally existing circumcision practices into advocacy for circumcision. Traditional male circumcision ceremonies offer the opportunity to integrate this efficacious practice while empowering communities. He conducted a pilot project during circumcision season in Kenya to examine feasibility and acceptability of incorporating HIV prevention, education and gender education messages. The target population was young men, elders, circumcisers and community members. At the conclusion of the trial, medically trained clinicians were brought from health care facilities to the village and incorporated into circumcision ceremonies while aiming to maintain tribal culture with the support of the community.

The impact of circumcision on sexual pleasure was also studied, with the outcome that circumcision had no detrimental effects on sexual pleasure or function. In fact, it was reported that circumcision made wearing condoms easier, which may result in greater use of condoms in general.

A concern raised from the floor is that the effect of male circumcision on women was of great concern and according to the presenters is still largely unknown.

The presenters were enthusiastic that male circumcision become implemented into policy as soon as feasibly possible, yet some limitations remain such as the standardization of circumcising practices and the uptake of this practice in communities. 



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