South Africa is the unenviable epicentre of the HIV pandemic with 0.7% of the global population sadly amassing 18% of the global prevalence. The government has expanded interventions over the years to quell the epidemic. Sadly however, 58% of South Africans eligible for ARV treatment remain unable to access it. Despite the strides made by government to alleviate the HIV burden, high HIV incidence rates of 16% were reported in 2013. We can gauge from this that the current prevention and treatment processes are failing. The question is: what alternatives do we have at our disposal? And could we gauge the potential success of these?
Randomised trials show that male circumcision reduces the prevalence and incidence of high-risk human papillomavirus (HPV) infection in men (1). However, the question was whether it also reduces the prevalence and incidence of high-risk HPV in the female partners of these men. In Rakai, Uganda, two randomised controlled trials of male circumcision where conducted between Read More
From 2002 until 2005 a male circumcision (MC) trial was conducted in Orange Farm. The trial showed a protective effect of MC of about 60%. Following this trial there was an ethical obligation of the funder to offer this effective treatment to the entire community. This project, which was named the Bophelo Pele Male Circumcision Read More
In the June issue of the SACEMA it was reported that here is strong evidence that medical male circumcision reduces the acquisition of HIV by heterosexual men, but that current evidence is lacking for whether it also offers protection for women (1). Recently an article has been published reporting on the results of a trial Read More
Our second quarterly epidemiological update features a report on the 4th South African AIDS Conference and two perspectives from guest authors on the evidence on the role of Herpes infection, and on the benefits of male circumcision. These are both hotly debated and present substantial challenges in rethinking the provision of prevention measures. We had hoped to provide a report on an important international gathering related to the ‘test and treat’ proposals for HIV. However, this exciting event was postponed on short notice, due to the swine flu outbreak.
Herpes Simplex Virus type 2 (HSV-2) is associated with an increased risk of HIV acquisition and transmission. HIV, in turn, increases the risk of HSV-2 transmission. This article presents the results of two studies, analyzing the interactions of HIV and HSV-2 infections and their transmission probabilities by using data from a randomized controlled trial on male circumcision conducted in Orange farm, South Africa.
In 2003 a Cochrane review concluded that male circumcision was associated with prevention of HIV, but until recently not enough evidence existed to support it as an intervention. However, with the results of three randomized controlled trials becoming available, the meta-analysis described in this article could conclude that there is now conclusive evidence that male circumcision is an effective procedure for preventing HIV acquisition.