An Ancient Medical Technique Fights a New Plague

Named by TIME magazine as the medical breakthrough of 2008, the ancient tradition of male circumcision is making a comeback as a way to prevent the transmission of HIV in Africa.

[ News Release 2009-30 ]

Africa has one of the highest rates of HIV and AIDS in the world. To respond to this challenge, numerous efforts have been made to stem the transmission of HIV in Africa. None has been as successful as male circumcision research done by Dr. Stephen Moses, a professor of medical microbiology at the University of Manitoba, and his colleagues.

In the late 1980s, Moses started working with the University of Manitoba/University of Nairobi research group at Kenyan medical clinics, which had noticed that circumcised males had lower rates of HIV infection than non-circumcised males. They did larger studies and published findings showing significant reductions of HIV among circumcised men.

However, despite similar studies in different countries consistent with Moses's research, many in the medical and public health community still had their doubts.

"It was very difficult to convince people that male circumcision was really associated with this reduced risk of HIV," said Moses. "Most of the studies were observational not experimental, and many people thought that it wouldn't be until the findings could be confirmed with randomized controlled trials that the evidence would be really convincing."

So, in 2002, after a few years of preparation, Moses and his group began a randomized controlled trial in western Kenya. They followed a large group of young men for several years, and they found that the circumcised men had a 60% reduced risk of acquiring HIV compared to the uncircumcised men. In fact the results were so convincing, the trial oversight board concluded that the study had to be stopped early, with circumcision offered to the control group.

Other groups in other parts of Africa have done similar studies and found the same range of reduced risk. As a result, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAID) have both endorsed male circumcision as a method of reducing the spread of HIV.

"Many countries look to the WHO and UNAID to set guidelines and policy in this area," said Moses. "The fact that they've endorsed these findings and have recommended male circumcision in appropriate contexts, especially in areas where HIV rates are high and circumcision is not widely practiced, is very important for HIV prevention."

Many countries in central and eastern Africa where male circumcision is not normally practiced have already begun to offer the service with initial results showing a very large uptake, which should translate into a slowing of the HIV transmission rate in those countries.

"It's been very exciting," said Moses. "There aren't a lot of HIV prevention technologies that have proven to be effective. Over the last few years a number of things that seemed to have promise have turned out to not work really well, so it's quite exciting to be involved in research into an HIV prevention method that has been proven to be enormously effective, not just in our hands, but by others as well."