HIV :: International AIDS Vaccine Initiative (IAVI) statement on male circumcision

The International AIDS Vaccine Initiative (IAVI) issued this statement today following a National Institutes of Health (NIH) decision to end two clinical trials of adult male circumcision in Uganda and Kenya. The NIH’s Data Safety and Monitoring Board (DSMB), reviewing interim data, found that medically performed circumcision significantly protected men in the trial from HIV infection.

IAVI recognizes the critical importance of interim data released today by the NIH suggesting circumcision may cut in half men?s risk of contracting HIV/AIDS through heterosexual sex. The two studies enrolling 2,784 HIV-negative men in Kisumu, Kenya and 4,996 HIV-negative men in Rakai, Uganda, demonstrated a 48% (Uganda) and 53% (Kenya) reduction of HIV acquisition in circumcised men relative to uncircumcised men. These data support the findings of a 2005 study, the South Africa Orange Farm Intervention Trial, funded by the French Agence Nationale de Recherches sur le SIDA (ANRS), which demonstrated at least a 60% reduction in HIV infection among circumcised men.

“We are enormously encouraged by these results,” stated CEO and President of IAVI, Dr. Seth Berkley. “Any method of prevention which could reduce new HIV infections ? now more than four million a year ? should be supported as part of a comprehensive response to the HIV/AIDS pandemic.”

“Within our own studies and vaccine candidate trials overseas, IAVI will work to ensure that World Health Organization (WHO) recommendations, as well as local and national guidelines concerning circumcision, are addressed as we continue to drive home key important public health messages. For example, men must continue to wear condoms for even with circumcision they remain at risk for HIV/AIDS and other sexually transmitted diseases, such as herpes, syphilis, and chancroid, which increase the risk of HIV/AIDS. We also are concerned that a lack of health infrastructure in some countries could jeopardize safe circumcision for many. Men who want to be circumcised as an HIV/AIDS prevention method ? a personal decision ? must seek out a qualified professional as we work to improve healthcare conditions in resource-poor countries.”

Although male circumcision has been shown to reduce HIV acquisition in circumcised men, HIV/AIDS requires a sustained and integrated approach to protect countless numbers of women and girls who were not the focus of the NIH-sponsored study results. We look forward to reviewing upcoming data from a Johns Hopkins University study assessing the impact of male circumcision on the risk of HIV transmission to female partners from HIV-infected men.

At the same time, the international community must continue to push for expanded access to current prevention and treatment options, as well as for critical new prevention technologies currently being developed and tested, including vaccines and microbicides. None of these interventions will be 100% effective on their own; they are complementary and should be used in combination as part of a broad HIV strategy. IAVI continues to believe that a preventive AIDS vaccine is the best hope of ending the pandemic. Even a modestly-effective AIDS vaccine could slash the number of new infections over a decade by one-third, savings tens of millions of lives worldwide.

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