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Outposts: Men, cross your legs

Thursday, May 08, 2008 - 05:37 PM

So if you read the previous post, you heard about the Rakai Health Sciences Program, a leader in HIV/ AIDS research that I visited yesterday. And you’ve probably heard about the ABC of HIV prevention: Abstinence, Be Faithful, and Consistently and Correctly use Condoms.

Condoms have been controversial of late, as in order to receive funding from href=”http://www.pepfar.gov/”>PEPFAR (the President’s Emergency Plan for AIDS relief), the ABC program must comply with the regulations of promoting abstinence over condom education.

Well there’s a new C in town, or to be accurate, there is now ABCC...

What’s the new C? Men, cross your legs, it’s male circumcision.

In 2005, a trial at the Rakai clinic saw a decrease of 51% in HIV infection in circumcised men. This was so significant a number that they stopped the trial 6 months earlier than planned and began rolling out a comprehensive circumcision program, which is now underway.

OK, the skinny on foreskins... Here's a box of them at the clinic about to be sent off for testing... eek.

uganda-134.jpg

Globally, 30% of the men are circumcised. Usually it’s done for religious or cultural reasons. It’s probably the oldest and most common form of surgery. So why does cutting off the foreskin better protect a person from HIV? Scientists suggest it's effective because cells inside the foreskin are an ideal breeding ground for the virus and allow it be passed on during sexual intercourse. Cut them out, and the breeding ground is gone. And, apparently size does matter; they have figured out that the larger the foreskin, the easier it is to be infected with HIV.

Next, I went to the circumcision surgery waiting room. A group of men from aged 15 to 61 were waiting in line to get circumcised. I tried talking to some of them about what led to their decision, but the uncontrollable giggling that erupted from the group led me to believe they were never going to talk about that decision with me (yes, I’m female). They didn’t mind my taking their picture, though.

uganda-135.jpg

Here are the issues:

Currently men from age 15 on are getting circumcised. What's the right age for circumcision to be performed? Babies, teens, adults? All of the above?

Who should consent for the children? There are a heartbreaking number of families without adults in this district due to parents who died from AIDS. More about those children later.

The doctor-to-patient ratio is overwhelming: 1 doctor to every 18,000 patients. Currently doctors perform the surgery, but that's probably not sustainable. Who, then, should perform the surgeries?

Should antibiotics be used, or could they create antibiotic resistance within the community?

How do you do appropriate follow up with a remote rural population?

Rakai is trying to answer those questions. And while we are on questions, here's a rhetorical one: Did you know, on average, it takes 1,000 unprotected sex acts with an infected partner to contract the HIV virus?

Would you like to read more on this circumcision study?

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