More HIV-positive with traditional circumcision in Lesotho

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Traditionally circumcised men are more likely to be HIV positive compared to men who underwent voluntary medical male circumcision (VMMC), found a Duke study conducted in Lesotho.

The traditional method does not completely remove the foreskin‚ which harbours cells targeted by the virus‚ the study says.

The research‚ says 90% of circumcised Lesotho men had the surgery done the traditional way‚ which is widely practised in South Africa.

“Depending on how the surgical operation is performed‚ male circumcision may not be protective in the prevention of HIV transmission‚” says Elisa Maffioli‚ from the Duke Global Health Institute in North Carolina‚ US.

“Traditional male circumcision‚ for example‚ does not often involve complete removal of the foreskin‚ but is more of a symbolic cut. A recent study of Lesotho Defence Force applicants showed that half of the men who reported that they were circumcised retained all or a portion of their foreskin.”

More than 3‚400 men were polled for the research. HIV prevalence in Lesotho is among the highest in the world‚ at 23.4% in adults between 15 and 49.

Presenting findings in 2008‚ French researcher Dr Bertran Auvert of Versailles University suggested that 40% to 50% of circumcisions in Southern Africa were “ritual” or “partial”, reports TimesLive.

HIV trials conducted in South Africa‚ Kenya and Uganda showed that only clinical circumcision could reduce the risk of males getting HIV‚ said Auvert.

“What I know is that not all who say that they call themselves ‘circumcised’ are clinically circumcised‚” he said.

“In fact their penises are completely intact.”

Inkosi Ngangomhlaba Matanzima‚ the chairman of the House of Traditional Leaders in the Eastern Cape‚ said he welcomed such research. But he dismissed the notion that traditional circumcision was merely symbolic.

“Traditional circumcision does not only mark a certain milestone in one’s life. It has always been about cleanliness as well‚ that was way before diseases such HIV and Aids.”

Abstract

In many developing countries, male circumcision has been promoted as an effective HIV prevention strategy, and medical randomized controlled trials have indeed shown a causal link. However, there is limited empirical evidence to support this conclusion in countries where individuals can voluntary opt for different types of circumcision. The present study considers male circumcision in Lesotho, where HIV prevalence is among the highest in the world (23%). Here, men can opt for one of two types of circumcision: traditional male circumcision in initiation schools, or the medical option in health clinics. This paper investigates whether the former has medical effects on individual HIV status that are as beneficial as those shown for the latter. Controlling for the potential individual behavioral response after the operation, it was found that circumcision performed in initiation schools wholly offset the medical benefits of the surgical procedure. This supports anecdotal evidence that the operation performed by traditional circumcisers does not have the same protective effect against HIV transmission as the medical operation. No evidence of “disinhibition” behavior among circumcised men was found, nor differential risky sexual behavior among men circumcised, traditionally or medically. Considering that, in Lesotho, traditional male circumcision is undertaken by more than 90% of circumcised men, the findings highlight the need for further research into how the operation in initiation schools is performed and its medical benefits.

TimesLive report
PLOS ONE study


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