Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Protection for women
A study in Uganda observed lower rates of male-to-female
transmission of HIV if the man was circumcised. 13 Among 47 couples
in which the circumcised male partner was infected with HIV and
whose viral load was below 50 000 copies per ml, none of the female
partners became infected in two years. By contrast, 26 of the 147
women whose HIV-infected partners were not circumcised became
infected.
A subsequent randomized controlled trial of circumcision among men
with HIV infection did not confirm this result. It showed there might be
a higher risk of HIV transmission to women in the first two years after
the operation. 22
A further observational study has shown a 40% lower risk of HIV
infection in couples where the male partner was infected and the
female partner not infected with HIV, but the reduction in risk was not
significant. 23
Other health benefits of circumcision
A multicountry study 24 found a lower prevalence of human
papillomavirus (HPV) infection in circumcised men than in
uncircumcised men. HPV infection is a necessary causal factor for
cervical cancer and is associated with an increased risk of cancer of
the vulva, vagina and anus in women, and of the penis and anus in
men. Prospective studies have shown that circumcised men are less
likely to have HPV infection. 25,26,27
The incidence of invasive penile cancer is significantly lower in
circumcised men than in uncircumcised men, though this condition is
extremely rare. 28,10
Acceptability of circumcision among African men
Surveys and qualitative studies among young as well as older men in
six African countries have found that a considerable proportion
expressed interest in circumcision, ranging from 45% in Harare,
Zimbabwe, to over 80% in a large survey in Botswana. 29 These
studies indicate that many men would willingly undergo circumcision if
it could be performed safely and at reasonable cost.
In the surveys, the men reported that their main interest in
circumcision was related to hygiene, infection control and, for some, a
belief that condom use is easier for men who are circumcised.
Male circumcision and HIV infection Chapter 1-6