Video Transcript - Video with Drs. Moses and Loolpapit - Show me the Evidence (Spring 2012, Volume 1, Issue 2)

[ Back to Show me the Evidence ]

34 million people are living with AIDS.

The disease has hit hardest in southern and eastern Africa.

In the mid-1980s, Dr. Stephen Moses started seeing evidence suggesting that male circumcision protected against transmission of HIV/AIDS.

Dr. Stephen Moses
Professor
Departments of Medical Microbiology
Community Health Sciences and Medicine
University of Manitoba

Dr. Stephen Moses: We started examining the relationship between male circumcision and risk for HIV infection back in the middle 1980s and it became apparent through clinical studies that men who were circumcised seemed to be at a lower risk of acquiring HIV infection than men who were uncircumcised. So it seemed at that point that there was something to it and the issue needed to be further pursued.

But observation was not enough to convince decision makers...

Dr. Stephen Moses: I think it became clear after some time that the standard of evidence needed in order for decision makers to adopt or promote male circumcision as an HIV prevention measure, the standard of evidence had to be extremely high, and the highest standard of evidence comes from randomized trials. So it became clear that data from randomized trials were required before circumcision was going to be promoted as an HIV prevention measure.

After early results showed evidence overwhelmingly in favour of the procedure, the trial was altered and circumcision was offered to all participants.

Dr. Mores Loolpapit
Associate Director
Family Health International (FHI 360)
Manager of the Male Circumcision Consortium in Kenya

Dr. Mores Loolpapit: There was a long debate for a long time as to whether male circumcision itself helped protect men from acquiring HIV. So, people really didn't know … When the results actually did come out it was quite surprising to a number of people, including even doctors and people in the health field.

The study helped spur action from the international community.

Dr. Mores Loolpapit: The study itself was fundamental in that it did help the global community recognize the value of male circumcision as an HIV prevention strategy and did help the various groups offering circumcision services begin to offer the services... It's really helped to reinvigorate in my view, HIV prevention and has really put in more energy into HIV prevention efforts.

CIHR support helped the study get off the ground.

Dr. Stephen Moses: CIHR really played a pivotal role. It was the first organization to provide funding for the trial and that really broke the ground. After CIHR funding was in place, we also received additional funding from other sources.

As of late 2011, over 600,000 circumcisions have been performed in Africa.

Cost of male circumcision per HIV infection averted: $150 – $900 over a 10-year period.

Cost of treatment of HIV infection with first-line antiretroviral therapy: more than $7,000 over a 10-year period.

Cost if treatment fails and follow-up therapy is required: more than $14,000 per HIV infection over a 10-year period.

Video footage of Dr. Loolpapit courtesy of FHI 360.