AIDS-ravaged Malawi debates male circumcision

BLANTYRE - AIDS-ravaged Malawi needs to make its own decision whether to adopt male circumcision in a bid to reduce levels of HIV infection, international experts said at a conference in Blantyre on Wednesday.

Representatives from the United Nations, foreign health organisations, the Malawian government gathered with local traditional healers in the commercial capital to discuss findings that show male circumcision can halve infection rates.

The medical community, impressed by the recent studies, is encouraging countries to pay note but without forcing them to a conclusion.

"Malawi needs to make its own decision on developing male circumcision services based on solid evidence and analysis," Hellen Jackson, UN Population Fund HIV and AIDS regional advisor for southern Africa, told AFP.

"Though as a high HIV prevalence country, Malawi cannot afford to ignore the evidence of a 50 percent or more protective impact," she said.

Jackson, one of the international experts at the two-day conference, said developing male circumcision services "is complex and should only be undertaken in the context of strengthened efforts for overall HIV prevention."

Saying prevention efforts include reduced partners, consistent condom use and wider sexual and reproductive health needs, she cautioned that "male circumcision is not a silver bullet, but it could be an important part of a wider HIV prevention package."

South African expert Dirk Taljaard told AFP at the conference that Malawi should pay close attention.

"In light of the evidence around male circumcision, it would be important for Malawi to investigate and debate the issues around circumcision as a country where prevalence of HIV is high and there is a generalised epidemic."

Taljaard, who works for Progressus, a South African research and development firm, said "the science is clear, male circumcision is partially protective and offers about 60 percent protection against HIV infection."

He said scientists and policy and lawmakers "cannot afford to ignore this possible contribution to prevention", but circumcision should be used in conjunction with other strategies to prevent HIV infection and not as a "permanent condom" or stand-alone strategy.

Taljaard said it was also crucial that cultural, social practices and values of any nation be taken into account whenever any HIV intervention was analysed.

Bizwick Mwale, executive director of the National Aids Commission (NAC), said Malawi wanted wider consultation before any decision is made to embrace male circumcision.

Trials conducted in Kenya, Uganda and South Africa found that men who were uncircumcised were twice as likely to contract the human immunodeficiency virus (HIV) compared with circumcised counterparts.

The data were so dramatic that the trials in Kenya and Uganda were halted ahead of schedule, for it would have been ethically wrong to continue them.

One theory behind circumcision`s protective effect is that the foreskin has a very thin epithelium, or lining, and easily suffers minor abrasions during intercourse.

These microscopic cuts make it easier for the AIDS virus to enter the man`s bloodstream.

Another mooted reason is that the foreskin is rich in so-called Langerhans cells whose surface configuration makes it easy for the virus to latch on to them.

Mwale said that the meeting would "basically analyse all data available supporting male circumcision".

"We also want to hear from UNAIDS for their perspective on this issue," the NAC chief added.

The conference is expected to hammer out recommendations to guide policy makers to decide whether to adopt male circumcision in HIV prevention.

Mwale said only about two percent of the population, mainly Muslims living along the vast Lake Malawi shore, has been circumcised on religious grounds.

Around 14 percent of Malawi`s 12 million strong population is infected with HIV, according to official figures. There are about 78,000 AIDS-related deaths and 100,000 new infections every year.

The pandemic has cut life expectancy in Malawi to 36.

02/28/2007 15:27 GMT

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