A World Health Organization (WHO) study released Monday raises doubts about the rapid implementation of male circumcision as a strategy to fight HIV/AIDS in Africa, where researchers found "shocking" rates of complications from the procedure. Studies have shown that male circumcision reduces the risk of female-to-male HIV infection by up to 70 percent.
The WHO study authors, Kenyan Omar Egesah and Robert Bailey and Stephanie Rosenberg of the United States, found that as many as 35 percent of males circumcised by traditional practitioners in Kenya's Bungoma district had complications, including bleeding, infection, excessive pain, and erectile dysfunction. "Other common adverse effects reported were pain upon urination, incomplete circumcision requiring recircumcision, and laceration," said the authors, estimating that 6 percent of patients had life-long problems as a result.
The researchers physically examined 298 of the 1,007 participants in the study; they intervened when they observed complications.
While male circumcision is universally practiced in Bungoma, the study indicated that many clinicians there lacked sharp and sterile instruments and few were formally trained. Even public clinics had a complication rate of 18 percent.
The study's findings "should serve as an alarm to ministries of health and the international health community that focus cannot only be on areas where circumcision prevalence is low," said the authors. "Extensive training and resources will be necessary to build the capacity of health facilities in sub-Saharan Africa before safe circumcision services can be aggressively promoted for HIV prevention," they wrote.
The study, "Male Circumcision for HIV Prevention: A Prospective Study of Complications in Clinical and Traditional Settings in Bungoma, Kenya," was published in the Bulletin of the World Health Organization (2008;86(9):657-736).
09/01/08
AFRICA: Circumcision Problems Impair HIV Prevention - Study
Source: Reuters:: Laura MacInnis; Courtesy of the CDC National Center for HIV, STD, and TB Prevention