Image: Teguest Guerma, Jos Perriens
Salvatore Di Nolfi  /  AP
Jos Perriens (left), Coordinator Prevention in the Health Sector Departments of HIV/AIDS World Health Organization, speaks next to Teguest Guerma, Associate Director Department of HIV/AIDS of WHO, about WHO's and UNAIDS' recommendations on male circumcision for HIV prevention.
updated 3/28/2007 4:56:20 PM ET 2007-03-28T20:56:20

U.N. health agencies recommended Wednesday that heterosexual men undergo circumcision because of “compelling” evidence that it can reduce their chances of contracting HIV by up to 60 percent.

But World Health Organization and UNAIDS experts said men must be aware that circumcision is only partial protection against the virus and must be used with other measures.

“We must be clear,” said Catherine Hankins, of UNAIDS. “Male circumcision does not provide complete protection against HIV.”

Men and women who consider male circumcision as an HIV preventive method must continue to use other forms of protection such as male and female condoms, abstinence, delaying the start of sexual activity and reducing the number of sexual partners, she said.

Otherwise, they could develop a false sense of security and engage in high-risk behaviors that could undermine the partial protection provided by male circumcision, the agencies said.

Men also should be warned that they are at a higher risk of being infected with HIV if they resume sex before their wound has healed. Likewise, an HIV-positive man can more easily pass on the disease to his partner if the wound is still unhealed.

The recommendations were based on a meeting earlier this month in Montreux, Switzerland, where experts discussed three trials — in Kenya, Uganda and South Africa — that produced “strong evidence” of the risk reduction resulting from heterosexual male circumcision.

“Based on the evidence presented, which was considered to be compelling, experts attending the consultation recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men,” a joint statement said.

Much depends on the situation in a given country, and little general benefit will result in countries where the HIV epidemic is concentrated among sex workers, injecting drug users or men who have sex with men, the agencies said.

The public health impact is likely to be most rapid where there is a high rate of HIV infection among men having sex with women.

“It was therefore recommended that countries with high prevalence, generalized heterosexual HIV epidemics that currently have low rates of male circumcision consider urgently scaling up access to male circumcision services,” the agencies said.

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Impact on women unknown
Studies suggest 5.7 million new cases of HIV infection and 3 million deaths over 20 years could result from male circumcision in sub-Saharan Africa, they said.

More study is needed to determine whether male circumcision will cut the transmission of HIV to women and the impact of male circumcision on the health of women for reasons other than HIV transmission, such as whether it lessens rates of cancer of the cervix.

More study also is required to find out whether male circumcision will reduce HIV infection in homosexual intercourse, it said, but it said promoting circumcision of HIV-positive men was not recommended.

“The recommendations represent a significant step forward in HIV prevention”, said Dr. Kevin De Cock, director of WHO’s HIV/AIDS department. “Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men.”

Increasing male circumcision in areas where it the procedure is rare will result in immediate benefit to the men circumcised, but it will take years before there will be an impact on the epidemic.

Although the rate of circumcision varies considerably from country to country, globally an estimated 665 million men, or 30 percent of men in the world, are circumcised, the statement said.

The agencies said the risks involved in male circumcision are generally low, but can be serious if the operation is performed in unhygienic settings by poorly trained, ill-equipped health workers.

Priority should be given to providing circumcision to age groups at highest risk of acquiring HIV because it will have the most immediate impact on the disease. But, it said, circumcising younger males also will have a public health impact over the longer term.

It gave no estimate how much providing the service would cost, but said more money would be needed.

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