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Male circumcision could help protect against HIV infection
SCIENCE AND MEDICINE
NEWS Mbeki defiant about South African HIV/AIDS strategy n an uncompromising rebuttal of criticism aimed at South Africa’s HIV/AIDS policy, President Thabo Mbeki called on scientists to have “sufficient tolerance to respect everbody’s point of view”. He spoke of the “desperate and pressing need to wage a war on all fronts” against an epidemic that affects one in five adults in his country. Mbeki used his opening address to the XIIIth International AIDS conference in Durban, South Africa, to compare the campaign against AIDS with the struggle against apartheid. Mbeki emphasised that “the world’s biggest killer and the greatest cause of ill-health and suffering across the globe, including South Africa, is extreme poverty”. He told a personal story of how he discovered Africa’s “health crisis of enormous proportions”, and his conclusion that “we could not blame everything on a single virus”. Despite this important African dimension to the pandemic, Mbeki assured delegates that “there is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of HIV/AIDS”. During Mbeki’s speech people in the audience shouted that such views had “nothing to do with our lives”. And later Jerry Coovadia, the conference chairman, noted that although poverty “exacerbated” HIV/AIDS, it
I
was “not the basic cause”. But the most moving plea for a more vigorous response to
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Mbeki stands firm on HIV/AIDS policy
HIV/AIDS came from Justice Edwin Cameron, a South African High Court judge living with AIDS. He argued that “in my own country, a government that in its commitment to human rights and democracy has been a shining example to Africa and the world, has at almost every conceivable turn mismanaged the epidemic”. Cameron spoke of “governmental ineptitude”, the “pitiously little” progress it had made, and Mbeki’s “intractably puzzling” association with AIDS dissidents. “I cannot believe that my President’s speech has done enough to counter these concerns”, he added. The South African Minister of Health Manto
Tshabalala-Msimang rejected Cameron’s argument. And she denounced the use of antiretroviral drug treatment as a litmus test for a strong HIV/AIDS strategy. In a review of what does constitute an appropriate global HIV/AIDS strategy, Roy Anderson (Oxford, UK) concluded that “rigour is not the issue of the day, reality is”. Policy makers need to implement fewer measures but be more effective in what they do, and on a larger scale. “Resource allocation does not in any way match the scale of the problem”, he added. Although noting that the burden of HIV-AIDS will continue to increase, Anderson saw “the beginnings of a recovery” in Uganda as “a glimmer of hope”. Irrespective of measures to provide antiretroviral drugs, control sexually transmissable disease, distribute condoms, and educate young people about risk, Anderson believes that a vaccine remains “the only hope for the longer term”. However, “the paradigm [of vaccine development] must be changed”. Low efficacy vaccines—as little as 20% in some low prevalence areas—could have dramatically beneficial effects. The success of any strategy depends on “strong political leadership”. With that remark, Anderson added his voice to those who were “disappointed” by Mbeki’s speech.
Male circumcision could help protect against HIV infection “
M
ale circumcision should now be seriously considered as a prevention strategy to reduce the spread of HIV”, said Anne Buvé (Institute of Tropical Medicine, Antwerp, Belgium) at the XIIIth International AIDS conference in Durban, South Africa. Buvé and colleagues investigated the effect of circumcision on the spread of HIV infection in two African cities with “low” (less than 5%) prevalence of HIV and two cities with “high” (greater than 25%) prevalence . They found that 99% of men in the low-prevalence
THE LANCET • Vol 356 • July 15, 2000
cities were circumcised, but that far fewer (28% and 9%) were circumcised in the two high-prevalence cities. In one city, HIV infection rates were strikingly different between circumcised (9·9%) and uncircumcised (26·6%) men. Buvé pointed out, however, that to substantially reduce HIV transmission, men would have to be circumcised before they reached sexual maturity. Furthermore, since there are doubts about the safety of circumcision procedures in parts of Africa, implementation of this policy would also have
important practical and ethical implications. Most importantly, the delegates were concerned that safe sexual practices might decrease if circumcision became perceived as providing full protection against HIV infection. Despite indecision about the appropriate population studies that need to be done, all the speakers agreed that randomised controlled trials examining the effect of male circumcision on HIV transmission are needed. Stephanie Clark
225
For personal use only. Not to be reproduced without permission of The Lancet.
NEWS Mbeki defiant about South African HIV/AIDS strategy n an uncompromising rebuttal of criticism aimed at South Africa’s HIV/AIDS policy, President Thabo Mbeki called on scientists to have “sufficient tolerance to respect everbody’s point of view”. He spoke of the “desperate and pressing need to wage a war on all fronts” against an epidemic that affects one in five adults in his country. Mbeki used his opening address to the XIIIth International AIDS conference in Durban, South Africa, to compare the campaign against AIDS with the struggle against apartheid. Mbeki emphasised that “the world’s biggest killer and the greatest cause of ill-health and suffering across the globe, including South Africa, is extreme poverty”. He told a personal story of how he discovered Africa’s “health crisis of enormous proportions”, and his conclusion that “we could not blame everything on a single virus”. Despite this important African dimension to the pandemic, Mbeki assured delegates that “there is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of HIV/AIDS”. During Mbeki’s speech people in the audience shouted that such views had “nothing to do with our lives”. And later Jerry Coovadia, the conference chairman, noted that although poverty “exacerbated” HIV/AIDS, it
I
was “not the basic cause”. But the most moving plea for a more vigorous response to
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Mbeki stands firm on HIV/AIDS policy
HIV/AIDS came from Justice Edwin Cameron, a South African High Court judge living with AIDS. He argued that “in my own country, a government that in its commitment to human rights and democracy has been a shining example to Africa and the world, has at almost every conceivable turn mismanaged the epidemic”. Cameron spoke of “governmental ineptitude”, the “pitiously little” progress it had made, and Mbeki’s “intractably puzzling” association with AIDS dissidents. “I cannot believe that my President’s speech has done enough to counter these concerns”, he added. The South African Minister of Health Manto
Tshabalala-Msimang rejected Cameron’s argument. And she denounced the use of antiretroviral drug treatment as a litmus test for a strong HIV/AIDS strategy. In a review of what does constitute an appropriate global HIV/AIDS strategy, Roy Anderson (Oxford, UK) concluded that “rigour is not the issue of the day, reality is”. Policy makers need to implement fewer measures but be more effective in what they do, and on a larger scale. “Resource allocation does not in any way match the scale of the problem”, he added. Although noting that the burden of HIV-AIDS will continue to increase, Anderson saw “the beginnings of a recovery” in Uganda as “a glimmer of hope”. Irrespective of measures to provide antiretroviral drugs, control sexually transmissable disease, distribute condoms, and educate young people about risk, Anderson believes that a vaccine remains “the only hope for the longer term”. However, “the paradigm [of vaccine development] must be changed”. Low efficacy vaccines—as little as 20% in some low prevalence areas—could have dramatically beneficial effects. The success of any strategy depends on “strong political leadership”. With that remark, Anderson added his voice to those who were “disappointed” by Mbeki’s speech.
Male circumcision could help protect against HIV infection “
M
ale circumcision should now be seriously considered as a prevention strategy to reduce the spread of HIV”, said Anne Buvé (Institute of Tropical Medicine, Antwerp, Belgium) at the XIIIth International AIDS conference in Durban, South Africa. Buvé and colleagues investigated the effect of circumcision on the spread of HIV infection in two African cities with “low” (less than 5%) prevalence of HIV and two cities with “high” (greater than 25%) prevalence . They found that 99% of men in the low-prevalence
THE LANCET • Vol 356 • July 15, 2000
cities were circumcised, but that far fewer (28% and 9%) were circumcised in the two high-prevalence cities. In one city, HIV infection rates were strikingly different between circumcised (9·9%) and uncircumcised (26·6%) men. Buvé pointed out, however, that to substantially reduce HIV transmission, men would have to be circumcised before they reached sexual maturity. Furthermore, since there are doubts about the safety of circumcision procedures in parts of Africa, implementation of this policy would also have
important practical and ethical implications. Most importantly, the delegates were concerned that safe sexual practices might decrease if circumcision became perceived as providing full protection against HIV infection. Despite indecision about the appropriate population studies that need to be done, all the speakers agreed that randomised controlled trials examining the effect of male circumcision on HIV transmission are needed. Stephanie Clark
225
For personal use only. Not to be reproduced without permission of The Lancet.