New York, NY — Mitchell Warren, Executive Director of the AIDS Vaccine Advocacy Coalition (AVAC) today issued the following statement regarding the new recommendations from the World Health Organization (WHO) and UNAIDS on male circumcision as an HIV prevention strategy.
“AVAC welcomes the new recommendations from WHO and UNAIDS on the range of policy, operational and ethical issues that will help guide countries about where and how male circumcision can be best implemented, promoted, and safely performed. These normative recommendations are essential to ensuring successful rollout of male circumcision to protect against HIV infection.
“Adding the offer of safe, sterile, voluntary male circumcision to existing HIV prevention programs could avert many infections and save many lives. These programs could also provide a new way to reach men and adolescent boys who are frequently under-represented in health clinics and HIV prevention programs.
“As important as the new recommendations are, though, they are only a first step in translating research findings into real public health impact. This international guidance document must now be complemented by funding, technical assistance and operational research at the country level to help national governments and health ministries develop and implement policies and programs to ensure that male circumcision is as part of a comprehensive package of prevention interventions.
“If these resources are not immediately forthcoming, there is a real risk that the benefits of male circumcision will be negated by complications relating to unsafe surgeries performed by unskilled practitioners seeking to profit from demand, which is likely to increase as news of these data spread through communities around the world.
“It is also absolutely critical to recognize the unanswered questions about male circumcision, including: whether it is safe for HIV-positive men and their partners; whether it provides any protective benefit to women who are sexual partners of circumcised, HIV-positive men; and whether it has any protective benefit in the context of anal sex.
“But not having all the answers should not stop us from making the first big steps of using the overall finding to help reduce new infections. Making and resourcing clear plans for filling in these gaps must be given equal priority to rollout based on what we know today.
“The benefits of male circumcision can only be realized if male circumcision is offered in programs that contain clear, cultural and context-specific messages and that explain the benefits and limitations of the procedure for men and their sexual partners and the importance of proper wound healing before resuming sexual activity.
“Policymakers will face complex decisions as they seek to implement these recommendations. Decisions about targeting high-risk men should be made with the utmost care, and it is also essential that circumcision not become falsely viewed as an indicator of HIV-negative serostatus. Programs must develop communications strategies and packages of services that counter this impression and meet the needs of HIV-negative men, HIV-positive men, and especially their partners.
“Research and dialogue are also needed now to explore the feasibility of rolling out infant circumcision. This approach will not show immediate benefits in terms of HIV incidence but can minimize risks and could be a highly cost-effective implementation strategy over the long term.”
AVAC’s report on understanding the results of the male circumcision trials as well as a detailed statement on research priorities for male circumcision and advocacy fact sheets for civil society in the US and in sub-Saharan Africa are available at www.aidsvaccineclearinghouse.org/MC.
About AVAC: Founded in 1995, the AIDS Vaccine Advocacy Coalition (AVAC) is a non-profit, community- and consumer-based organization that uses public education, policy analysis, advocacy and community mobilization to accelerate the ethical development and global delivery of AIDS vaccines and other prevention options.