Millions of ‘snips’ will bolster our health system

Abstract

Scaling up male circumcision (MC) coverage to 80% of men and neonates in South Africa over the next 55 years would avert more than 11 million new HIV infections by 2025 -- but this is unlikely to happen.

The startling prevention claim emerged from modellling data presented by Kelly Curran, Technical Director of the HIV/AIDS and Infectious Diseases Department at Johns Hopkins University, who was in Cape Town this October to attend an AIDS/TB meeting of global researchers. She told Izindaba that MC trials in Uganda, Kenya and South Africa had shown a 60% reduction in HIV infection among heterosexual men, prompting aggressive World Health Organization (WHO), guidelines for high HIV, low male circumcision prevalence countries 2 years ago.

The goal now was to increase the scale-up of MC coverage among young men to 80% over the next 5 years in 13 eligible countries in Africa’s eastern and southern regions, namely South Africa, Namibia, Botswana, Swaziland, Lesotho, Malawi, Zambia, Zimbabwe, Mozambique, Tanzania, Kenya (Nyanza Province only), Uganda and Rwanda. Nyanza Province in Kenya was identified because it had low male MC coverage and an HIV prevalence three times higher than the rest of the country.

Curran said that in spite of the start-up difficulties, the payoff was huge. Modelling exercises suggested that the cost of averting an estimated 4 million new HIV infections in the 13-country region over 5 years would be around R7.5 billion – eventually saving R150 billion in treatment costs. ‘That’s a pretty small investment for such a big return,’ she said.

Similar modelling predicts that a scale-up of such magnitude (over 5 years) would in South Africa alone avert 20% of new infections and avoid more than 1 million new HIV infections in 15 years’ time (when the incremental effect has kicked in). Reaching 80% coverage in all 13 countries would require approximately 28 million procedures over 5 years.

To stress just how effective male circumcision was, Curran said a modelling exercise in Swaziland assessing the number of procedures that were required ‘per infection averted’ showed that as few as five circumcisions would avert one infection.
This had ‘huge potential’ for countries with high HIV incidences such as South Africa.