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Male Circumcision as the Answer to the African AIDS Epidemic?

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He said that circumcision is rare in the "AIDS Belt" of southern Africa, but common in West Africa, where AIDS rates are considerably lower.

"The evidence is strong enough, at least in my mind, to start trying to use circumcision as an intervention in AIDS," said Anne Buve, MD, of the Institute of Tropical Medicine in Antwerp, Belgium. "Male circumcision should be seriously considered as a preventive strategy."

In her study, Buve reported that in two cities in West Africa -- Yaoundé, Cameroon, and Cotonou, Benin -- the prevalence of HIV among sexually active adult men was less than 4.5%. Almost all men in those cities are circumcised. In contrast, circumcision was less common in Kisumu, Kenya, and in Ndola, Tanzania. Only about 10 to 25% of men are circumcised in those cities, but up to 25 % of the men have contracted HIV.

Eugene McCray, MD, tells WebMD, "The question of using circumcision as an intervention against HIV infection is very community-specific. You have to demonstrate that the operation will be accepted in the community before it can be attempted." McCray is the head of the CDC's global initiative to fight AIDS based in Atlanta.

Addressing that concern, Bailey said he and his colleagues conducted a series of interviews about circumcision with Kenyan men and women. More than 90% of those interviewed were uncircumcised.

Bailey said the focus group discussions determined that those interviewed were interested in circumcision because they believed it made it easier for men to maintain sexual cleanliness; because uncircumcised men were perceived as being more likely to contract a sexually transmitted disease; and uncircumcised men were believed to enjoy sex less and give women less sexual satisfaction.

"Given a choice, 60% of uncircumcised men would prefer to be circumcised, and 62% of women would prefer a circumcised partner," Bailey said. He was surprised at the results because few, if any, of the 110 women interviewed had ever had sex with an uncircumcised man.

McCray says, "The CDC is willing to support pilot projects to look at circumcision as a way to combat AIDS." He said such studies might be difficult to establish due to ethical concerns.

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