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Research Article

Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study

  • Agnes Binagwaho mail,

    abinagwaho@gmail.com

    Affiliation: Ministry of Health, Kigali, Rwanda

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  • Elisabetta Pegurri,

    Affiliation: UNAIDS, Kigali, Rwanda

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  • Jane Muita,

    Affiliation: UNICEF, Kigali, Rwanda

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  • Stefano Bertozzi

    Affiliation: Centro de Investigación Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico

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  • Published: January 19, 2010
  • DOI: 10.1371/journal.pmed.1000211

Reader Comments (2)

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ABC, not circumcision

Posted by ml66uk on 03 Mar 2010 at 15:12 GMT

A Rwandan man is *more* likely to be HIV+ if he's been circumcised. Why then would anyone want to promote male circumcision to prevent AIDS?

Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, *Rwanda*, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In *Rwanda*, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

References:

Cameroon http://www.measuredhs.com... table 16.9, p17 (4.1% v 1.1%)
Ghana http://www.measuredhs.com... table 13.9 (1.6% v 1.4%)
Lesotho http://www.measuredhs.com... table 12.9 (22.8% v 15.2%)
Malawi http://www.measuredhs.com... table 12.6, p257 (13.2% v 9.5%)
Rwanda http://www.measuredhs.com... , table 15.11 (3.5% v 2.1%)
Swaziland http://www.measuredhs.com... table 14.10 (21.8% v 19.5%)

South African National Communication Survey on HIV/AIDS, 2009
http://www.info.gov.za/is...
"12-22% of men and 12-17% of women across age groups (15% in total) also believe that circumcised men do not need to use condoms."

See also http://www.iasociety.org/...

"Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs."

http://apha.confex.com/ap...

"Results: … No consistent relationship between male circumcision and HIV risk was observed in most countries."

No competing interests declared.