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VMMC cuts female HIV risk by as much as 30%

Ground-breaking research presented at the recent International AIDS Society Conference on HIV Science IAS 2017 in Paris, suggests that voluntary medical male circumcision (VMMC) could lower HIV risk for women by as much as 30%, says an IoL report.

It is already well-known that women whose male partners are circumcised can benefit from a reduced risk of genital ulcers, sexually transmitted infections (STIs), such as herpes and syphilis, bacterial vaginosis and T vaginalis, but until now there has been little evidence of its protective benefits against HIV for women. Rachael Rawlinson, COO for CareWorks – an HIV management organisation – describes in the report, the research as a break-through discovery.

Almost a decade ago, a meta-analysis found no evidence to suggest that male circumcision directly reduced the risk of women acquiring HIV. It only pointed to lowering a man’s lifetime risk of contracting HIV by 60%, which makes this new finding so significant. Now there’s no disputing VMMC as an important HIV prevention measure, which has benefits for both men and women,” she says.

The report says the study was conducted in KwaZulu-Natal where HIV prevalence is high, and analysed data from the HIV Incidence Provincial Surveillance System – a longitudinal cohort which comprised 4 766 women between the ages of 15 and 49. Researchers found that women whose most recent partner was circumcised had lower rates of HIV (42%) than women whose partner was not circumcised (54%).

In a multivariable analysis, which attempted to control for the skewing effect of the differences between the two groups of women, such as age, women with circumcised partners had a 30% lower likelihood of having HIV and were also less likely to have herpes.

Of the men who participated in the same study, those who were circumcised were less likely to have HIV and STIs – adding weight to previous study findings. Rawlinson points out that another plus for female partners is that male circumcision plays an important role in curbing the incidence of cervical cancer, which is the most common female cancer in women aged 15 to 44 years in South Africa.

“A Ugandan study revealed that the prevalence of the human papilloma virus (HPV) – responsible for most cervical cancer cases – was 35% lower among the group of circumcised men who participated in the trial, which significantly decreases the risk of passing the virus on to women.”

The report says local female celebrities, such as actress, Renate Stuurman; Nomalanga Shozi of Rhythm City fame; model and Muvhangu actress, Omuhle Gela; pop singer, Thembi Seete; media personality, Khutso Theledi; Binnelanders actress, Quanita Adams and model and TV presenter, Refilwe Modiselle have all come out in support of voluntary medical male circumcision during National Women’s Month this August as part of Community Media Trust’s (CMT) “Man Up” campaign to create broader awareness around the benefits of VMMC.

Renate Stuurman says the campaign creates an environment for men (and women) to openly discuss what can sometimes be a sensitive issue, to protect themselves and their family. “It’s a simple procedure that has real life benefits.”

The report says since 2010, the demand for VMMC has increased primarily because of government’s efforts to curb new HIV infections in the country, but more men still need to be cut to make a difference.

Background: Randomized controlled trials and observational data have demonstrated that circumcision partially protects men from acquiring HIV and some sexually transmitted infections (STIs) through heterosexual sex. They also suggest that female partners receive some protection, possibly indirectly through lower infection prevalences among men. However, population-level data outside experimental settings is lacking. The HIV Incidence Provincial Surveillance System (HIPSS) is a longitudinal study in Vulindlela and Greater Edendale sub-districts, South Africa, which collected population-level baseline data in 2014 and 2015.
Methods: Female HIPPS participants were aged 15-49 years. Those with at least one past or current male sexual partner who were able to report his circumcision status were analyzed. Participants were assessed for HIV status via double 4th-generation ELISA testing with confirmatory Western Blot; N. gonorrhoeae, C. trachomatis, T vaginalis, and HPV infection with standard testing of self-collected vulvovaginal swabs; T. pallidum, HSV-2 and Hepatitis B with serology; and STI diagnosis history and current STI symptoms with self-report. They were grouped by circumcision status of their most recent partner, stratified into age below or at least equal to 25 years, and compared on presence of STI outcomes by chi-square testing, weighted for selection probability and nonresponse.
Results: 4766 women were included. Women with circumcised partners had similar numbers of lifetime partners (mean 2.45) to those with uncircumcised partners (mean 2.71). In the younger stratum, partner circumcision was negatively associated with HIV (24% vs. 35%, p< 0.01) and HSV-2 (49% vs. 62%, p< 0.01). In the older stratum, partner circumcision was negatively associated with syphilis (1.5% vs. 3.4%, p=0.04) and HSV-2 (83% vs. 86%, p=0.04), but was associated with ever having had an STI (11% vs. 7%, p< 0.01).
Conclusions: Partner circumcision was associated with decreased prevalence of HSV-2 in all female HIPSS participants, decreased prevalence of HIV in younger women, and decreased prevalence of syphilis in older women. Its positive association with self-reported STI history in older participants may derive from differential ascertainment; circumcision typically involves STI screening in men, potentially leading to partner notification. Findings support community-level protection against HIV and some other STIs among women from male circumcision.

S Davis, C Toledo, L Lewis, C Cawood, A Bere, M Glenshaw, A Kharsany


Prince Nhlanganiso Zulu, son of King Goodwill Zwelethini, has called on Zulu men across the country to circumcise. His announcement about MMC, in the name of the king of the Zulu nation, is only the second time that a public edict of this type has been made since the nineteenth century when King Shaka banned circumcision so his warriors could focus on war.

“Now we are fighting a different war and this is the war on HIV/Aids. It is not acceptable that KZN has the highest rates of HIV/Aids in South Africa and we need to do everything possible to fight back,” said Prince Zulu. “Part of a living a healthy lifestyle in Zulu culture must involve circumcision. Men must take responsibility for their health and for the health of their loved ones by being medically circumcised. We implore them to go without delay. The procedure is quick, safe and free, with medically proven benefits.”

The prince initiated and drives the Isibaya samaDoda programme to raise awareness on mental and physical health and social issues which pertain to men. “A real man takes care of his family and has one sexual partner,” Zulu emphasised. Isibaya samaDoda loosely translates to an enclosure or gathering area for men.

Around 150 taxis have been branded with the MMC message were in Durban and other parts of KZN as a reminder to men to book their appointment to be medically circumcised at their nearby clinic. Over 80 men came forward and had the procedure done immediately after the call by the prince on Friday.

The call was supported by the USAID-funded Voluntary MMC consortium comprising Right to Care, CHAPS and SACTWU that has been working with popular soapie star and Brothers for Life ambassador Kagiso Modupe on a campaign promoting MMC.

Modupe, 33, was medically circumcised earlier this year whilst openly discussing the issues that many men and women have around circumcision. These include pain which is mild, the six-week healing period which requires abstaining from sex or masturbation. He called on 2000 men to circumcise with him and was delighted when 5,000 men joined him.

Dr Khumbulani Moyo, medical male circumcision manager for the MMC consortium says, “Medical male circumcision is proven to reduce the risk for men and women of getting infected by HIV and other sexually transmitted infections and to reduce risk for cervical, anal and prostate cancer. But barriers to MMC remain high. Kagiso Modupe has played a powerful role in promoting medical male circumcision as the right thing to do.”

Medical male circumcision is central to South Africa’s HIV prevention policy. The National Department of Health aims to have 4.3m men circumcised from 2010 to 2017.

[link url="https://www.iol.co.za/lifestyle/health/male-circumcision-can-reduce-hiv-risk-for-women-by-30-10739039"]IoL report[/link]
[link url="http://programme.ias2017.org/Abstract/Abstract/2833"]IAS 2017 abstract[/link]

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