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At the heart of general practice since 1960

Call for more NHS circumcisions to cut HIV rate

By Emma Wilkinson

Men recently emigrated from countries with HIV epidemics, like sub-Saharan Africa, should be offered circumcision on the NHS, says a leading public health expert.

He has also called for a UK trial to assess circumcision for HIV prevention in men who have sex with men.

Professor Harold Jaffe is head of the department of public health at the University of Oxford and was previously director of the US National Centre for HIV, STD, and TB Prevention.

His warnings in Sexually Transmitted Infections, come after the World Health Organisation recommended scaling up access to male circumcision services in areas of the world with high prevalence, generalised heterosexual HIV epidemics.

Three African trials have shown that circumcision halved the rate of HIV infection in heterosexual men.

Professor Jaffe said current UK practice was to discourage the procedure in adults but NHS bodies needed to re- examine their policies.

He added that the yearly number of new UK HIV diagnoses had increased by 157% since 1997 and of the new diagnoses reported in 2006, 12% were in black African men and 36% were in men who have sex with men.

‘New prevention strategies for these groups are urgently needed, he said.

‘The UK has the opportunity to lead in revising its male circumcision guidelines in accordance with new African data and to develop data upon which to consider new circumcision strategies for men who have sex with men.'

But his comments were dismissed by Dr Colm O'Mahony, past president of the British Association for Sexual Health and HIV and Consultant in Genito-Urological Medicine at the Countess of Chester Foundation Trust Hospital.

He said: ‘Anything that runs the risk of diluting the message that unprotected sex causes HIV infection is unhelpful to say the least.

‘And data released last month suggests circumcision has no effect at all on male-to-female transmission.

Dr Richard Ma, north London GP and member of the RCGP sex, drugs and HIV working party said: ‘I don't think this will work in the UK. It's difficult to see how merely circumcising men who want to be circumcised is going to make any impact on HIV rates in this country - which are still relatively small.'

Circumcision and HIVCircumcision and HIV Circumcision and HIV

Only 16% of UK men aged 16 to 44 have been circumcised
An estimated 30 000 circumcisions are carried out in England each year.
A recent study of gay US men suggested more than half would be willing to be circumcised to reduce their risk of HIV infection
Studies in Africa suggest circumcision reduces female-to-male HIV transmission by at least 50%

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