VIENNA, Austria – Much of the excitement at the just-concluded AIDS conference here centered around the news of microbicidal trials that have shown to be almost 40% effective. While this is exciting and encouraging news, we are still years away from having this product on the market. Meanwhile, there is a proven and effective HIV strategy that reduces transmission by nearly 60% and doesn’t depend on remembering to use it every time you have sex. But it got much less attention at the conference than the microbicidal gel.
I’m talking about male circumcision (MC). But at least at this year’s AIDS conference, MC, for the first time, got some attention.
Two years ago in Mexico City, nary a word was said about male circumcision — and certainly not in a plenary meeting — despite the fact that its effectiveness had already been proven. PSI, one of our member organizations, did organize a press conference on MC, which was successful in generating some media buzz and attention. However, donors and governments, for the most part, continued to sleep and do little to scale up an intervention that could have saved millions of lives.
In December 2008, the Gates Foundation became the first donor to scale up MC, quietly providing funding for PSI to expand its male circumcision pilot project in Zambia to two other countries (a third country was added later). There was no fanfare, no announcement, as everyone was concerned about provoking a negative reaction for an intervention that addressed long-standing cultural practices.
However, that negative reaction never came, and now the environment seems to have changed, and MC seems to be going mainstream. Both Bill Clinton and Bill Gates mentioned MC prominently in their speeches in Vienna. In particular, Bill Gates could hardly stop talking about the wonders of MC, calling it and prevention of mother-to-child transmission two of the interventions that “are so effective that in endemic countries it is more expensive not to pursue them.” While more than 41 million men in sub-Saharan Africa could benefit from the procedure, he said, just 150,000 have been circumcised in the past few years.
“I have to admit: When it comes to circumcision, I used to be one of the skeptics,” he said in his speech. “I thought: ‘Sure, it reduces transmission by nearly 60%. But there’s no way that large numbers of men will sign up for it. I’m glad to say I was wrong. Wherever there are clinics available, men are volunteering to be circumcised in far greater numbers than I ever expected.”
It is an intervention whose time seems to have come. In a press conference in Vienna, PSI said that scaling up MC to reach 80% of adult and newborn males in Eastern and Southern Africa by 2015 “could avert more than 4 million new HIV infections between 2009 and 2025 and could yield a total net savings of US $20.2 billion during the same time period. And without any promotion or advertising of any kind, the demand for MC exceeds the supply. For every man we reach with the male circumcision services that he already wants, the fewer new HIV infections will be produced.
Like Bill Gates said, it’s so effective that it’s more expensive NOT to do it.