Sunday, April 22, 2012

2007 Rakai Trial Found Genital Hygiene More Effective Than Circumcision

Some time ago, I wondered out loud if penile hygiene could be more effective than mass male circumcision when it comes to reducing HIV transmission. It's certainly cheaper, more appropriate and should carry fewer risks. Even men who are circumcised still need to practice genital hygiene and use condoms. A research project to find out if penile hygiene would be acceptable, convenient, practicable and if adherence would be high, received funding a few years ago. As far as I know the findings have not yet been reported.

But it turns out that the Rakai circumcision trial, which made its findings public in 2007, also found that penile hygiene is a lot more effective than mass male circumcision. The findings for the relative effectiveness of penile hygiene were reported. But those who continue to urge for circumcision, many of whom would have been involved in the Rakai study (or one of the other studies), have chosen to ignore the more effective, safer and cheaper option. Yet men who remained uncircumcised and waited at least 10 minutes after coitus faced a far lower risk of being infected with HIV than men who were circumcised.

Men are advised to use a dry cloth rather than water. Coupled with the advice to wait a while this could be seen as complicated. But circumcision doesn't obviate the need to take this advice. Therefore circumcision is not just very expensive and has potential risks in countries where health services can be very unsafe, it also gives less protection than something that could already be second nature to most men. The biggest mystery, though, is why there is so much pressure to spend what would probably amount to several billion dollars to circumcise tens of millions of men when those advocating for the campaigns had access to this information at least five years ago.

Dr David Gisselquist has written extensively on this subject on the Don't Get Stuck With HIV website. He has also created a table showing that, according to the Rakai trial data, the biggest reduction in HIV transmission is among those who remained uncircumcised but waited at least 10 minutes after coitus to clean their penis. Hundreds of thousands of circumcisions, perhaps millions, have already been carried out, ostensibly to reduce HIV transmission; tens of millions are planned in adults, children and infants. It is vital that those being persuaded to have the operation have access to all available information in order for them to give informed consent. So far, they only appear to have been given information calculated to bias their decision towards circumcision.


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