What Works for Women and Girls

circumcision alone, men are not fully protected and their partners are not directly protectedfrom HIV infection” (Hankins, 2007: 65).How can male circumcision be effectively introduced so that it complements and doesnot detract from other prevention strategies? Will male circumcision affect women’s ability tonegotiate condom use? Will male circumcision confer any protection during anal sex? (AVAC,2007) These questions will need to be addressed as male circumcision is rolled out. It is clearthat male circumcision is an important component for HIV prevention strategies, but theextent to which it protects women is, while promising for the long term, unclear about women’srisk in the short term. “From the standpoint of public health, the risks of circumcision, suchas procedure-related infection, must be weighed against the relative protection it offers againstHIV infection. As with any HIV prophylaxis strategy, it is also important to consider that falsesecurity arising from use of a partially effective risk reduction strategy may, because of anincrease in the frequency of unsafe sexual practices, result in a paradoxical increase in HIVtransmission” (Cohen, 2007: S290).What Works—Prevention for Women: Male CircumcisionPromising Strategies:1. Male circumcision reduces HIV acquisition for men and may reduce transmission forwomen.2. Male circumcision at birth can reduce HIV incidence for both men and women whencircumcised boys become sexually active.EVIDENCEPromising Strategies:1. Male circumcision reduces HIV acquisition for men and may reduce transmission forwomen.A randomized controlled study from 2002 to 2004 of 3,274 young, sexually active,heterosexual men in South Africa found that with 18 months of follow-up, 60% fewermen who had been circumcised acquired HIV as compared to men who had not beencircumcised. There were 20 men who acquired HIV among those who had been circumcised,an incidence rate of 0.85 per 100 person years and 49 men who acquired HIVamong men who had not been circumcised, an incidence rate of 2.1 per 100 personyears. Male circumcision was offered to the control group at the end of trial. At each of68 CHAPTER 3 PREVENTION FOR WOMEN