Archive 2003


Newly circumcised Ogiek boys after coming out of seclusion in the Mau forest. Young men from communities that do not traditionally circumcise men are turning up for the cut.


Thursday October 09, 2003

Rush for new Aids trials

Young men go for the 'cut', believing it reduces risk of infection

By Arthur Okwemba

Study to establish if circumcision reduces HIV infections has attracted many young men at Kisumu. offering themselves for circumcision in a study that seeks to establish if the cut makes a man less vulnerable to HIV infection.

By last month, since the research started last year, 348 out of the 741 HIV-negative males enrolled in the study which started last year and targets the 18-25-year-old bracket had been circumcised.

Six of them have withdrawn after they made what the researchers describe as unreasonable demands.

Researcher Robert Bailey said the team had screened 1,339 young men for circumcision by last month, 99 per cent of whom were accepted. Between 4,500 and 5,000 are required as study samples. Just over 20 either declined or postponed the operation.

Another four, who were not circumcised, but used as part of the control group (volunteers whose performance will be compared with results from the circumcised group to test the method's efficacy) insisted on being circumcised.

They walked out when the researchers refused to do so and went to private clinics. With more than 96 per cent of the young men coming from communities that do not traditionally circumcise men, the interest in the study is overwhelming.

Kenya is one of the few countries to launch such a study. Others are South Africa and Uganda. The principal investigator, Prof Ndinya Achola, says that no incentives are being given. The young men only get free medical care. The results are expected in 2007.

Some scientists postulate that increased sexual pleasure for circumcised men, good hygiene and the thought of protection from HIV infection might be the factors driving the young men to the ritual.

During the 13th International Conference on Aids and Sexually Transmitted Infections in Africa (Icasa), some participants questioned the ethics and the safety of carrying out such a research.

They were concerned that, in some instances, men had died during operations that went haywire. Some circumcised men have unprotected sex under the false knowledge that they are insulated.

But the researchers insist that the operations are safe since doctors do it under the supervision of officials from the Data Safety Monitoring team of Kenyan and American experts.

They say the volunteers are counselled and advised against the mistaken belief that circumcision will protect them against infection.

Last year, the study ran into trouble with the Kenyatta National Hospital Ethics and Research board, which at one point even stopped it.

The board was concerned that specimens from many study subjects were shipped abroad for further analysis.

But the study has since picked up. Prof Bailey and his team say their objective is to ascertain whether or not circumcision reduces the risk of HIV infection.

"Many studies to date have only compared HIV incidence in communities that circumcise against those who do not, but do not offer strong and conclusive evidence showing that circumcision lowers the risk of HIV infection," he said.

When the news of the study was first broken last December, Prof Achola said the study wanted to provide empirical evidence on the relationship between circumcision and HIV infection.

This would justify or refute findings of other studies that have made comparison between HIV and circumcision using untested data.

All these studies are aimed at putting to rest bitter arguments between doctors on whether or not circumcising men plays a role in HIV prevention.

Proponents of the theory that circumcision prevents HIV infections say circumcised men have low viral loads and are, therefore, less likely to transmit the virus to female partners.

It is argued that the foreskin has a high density of cells known as Langerhans, which, they think, represent a possible source of the first conduct and one that provide an environment for HIV infection.

In Lancet No 8660 (1989), D. Cameron wrote that and others in their paper Female to Male transmission of HIV type 1: risk factors for seroconversion in men, claimed that the foreskin might provide an environment enabling bacteria and viruses to survive long enough to increase the likelihood of HIV infection.

Others note that the foreskin is susceptible to bruises that increase the chances of contracting the virus.

Some scientists, however, scoff at these arguments, saying these conclusions are not foolproof.

In a paper called "Male Circumcision: A role in HID prevention", Dr. Die Vincent argues that " the evidence for an association, at least from small-scale surveys, is doubtful and hence not conclusive enough to qualify circumcision as an intervention."

Still others dismiss the existing studies outright, saying they do not show evidence of a causal relationship between circumcision and a reduced HID infection rate.

Besides scientific arguments, certain economic, gender and cultural issues question the supposed link between circumcisions and HID prevention.

Some scientists have expressed concern that, if the method is accepted as a prevention against HID infection, the costs of mass circumcision of males might increase dramatically and make it undesirable.

For example, Mutterer University lecturer Jams Matzo says the idea may push governments into diverting money from other social needs to circumcision, which would be counter-productive.

Others fear it would leave women more vulnerable to infection since some circumcised men engage in unprotected sex thinking they are safer.

The Horizons, a journal of the Population Council, cautions that circumcised men are likely to use their status as a reason for not avoiding condoms. Women, too, might be less inclined to insist on condoms.

Such a scenario exposes women to more infection risk. Some argue that increased cases of circumcision may encourage communities practising Female Genital Mutilation (FGM) to continue with it, thus intensifying another social problem.

Other critics say the research is likely to interfere with the cultural practices of some communities those who do not practise it and consequently elicit a negative reaction.

Indeed, experts at Icasa and the International Aids Conference in Barcelona, HIV experts called for studies to establish circumcision acceptability by communities that do not practise it.

Related to this is the age at which a person needs to be circumcised. Past research shows that circumcision as an HIV prevention is effective if done soon after puberty.

Studies by Kelly Kiwanuka on the age of male circumcision and risk of prevalent HIV infection in Uganda found that men circumcised before puberty had a much reduced risk of prevalent HIV infection.

If so, the new research that targets those in late teens and early 20s may not yield the best results.

- An AWC Feature

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Young Ogiek Initiates after circumcision. Increased sexual plesure, good hygiene and the thought of protection from HIV infection are driving the young men to the ritual.