Tuesday, June 2, 2009

The cost and impact of male circumcision on HIV/AIDS in Botswana

The estimated HIV prevalence in Botswana is currently an overwhelming 25.7 percent. The Ministry of Health recently added the promotion of male circumcision to its HIV prevention strategy as three randomized controlled trials in South Africa, Uganda, and Kenya found that HIV transmission from females to males was reduced by up to 60% when males were circumcised.

This study examined the cost and effect of scaling up male circumcision which is currently listed as a strategy to harnessing the spread of HIV in the UNAIDS/WHO Decision-Makers' Program Planning Tool. The researchers ran different scenarios to measures the cost and impact. They found that scaling-up both adult and neonatal male circumcision to reach 80% coverage by 2012 would result in the prevention of almost 70,000 new HIV infections through 2025. The price for such a strategy which would be $47 million meaning an average of $689 would be spent per HIV infection. When they changed the target date to 2015, they found that they could avert approximately 60,000 new HIV infections through 2025. From 2008 to 2015, 27.3 male circumcisions would be required to avert one HIV infection. This number would decrease to 7.3 circumcisions from 2016 to 2025 because of the increasing impact of circumcision over time.

The authors of the study say that "scaling up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly." While male circumcision does have potential, there are a lot of things that need to be considered before scaling up male circumcision. The first is that is it safe? Can the male circumcisions be performed with sterile tools by people who have trained to do so? Secondly, I think there is a danger in treating male circumcision like condoms; male circumcision does not necessarily guarantee protection from HIV every time a man has sex (well neither do condoms, but I think you get my gist...). Also, do you think it's a good use of $47 million, and how does one go about encouraging thousands of men to be circumcised when it is not a part of their culture? There are a lot of things to be considered, but I still think that studies like these are important because they offer the numbers that often serve as the stimuli for the development of policy.

For the full article: http://www.jiasociety.org/content/pdf/1758-2652-12-7.pdf


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