What Works for Women and Girls

four visits, each participant was invited to a counseling session of 15 to 20 minutes deliveredby a certified counselor about HIV. Condoms were provided. STIs were screenedand treatment. No deaths occurred due to circumcision. Circumcision was conductedby general practitioners and resulted in a limited and reasonable number of adverseevents (Auvert et al., 2005). (Gray II) (male circumcision, condoms, South Africa)A randomized controlled trial of 2,784 men aged 18 to 24 years in Kisumu, Kenya,with a follow up of 24 months found that 22 men who were circumcised acquired HIVcompared to 47 men who had not been circumcised. The two-year HIV incidence was2.1% in the circumcision group and 4.2% in the group of men who had not been circumcised.Circumcised men had a reduction in the risk of acquiring HIV of 53%. Adjustingfor non-adherence to treatment and excluding four men who tested HIV-positive priorat enrollment in the study, the protective effect of circumcision was 60%. “Circumcisionwill be most effective if it is not perceived as a stand-alone procedure, but as one componentof a full suite of HIV prevention and reproductive health services, including HIVtesting and counseling, diagnosis and treatment of sexually transmitted infections,condom promotion, [and] behavioral change counseling and promotion….” (Bailey etal., 2007: 655). (Gray II) (male circumcision, Kenya)A randomized trial in Rakai, Uganda with 4,996 uncircumcised HIV-negative menaged 15 to 49 years of age found that HIV incidence over 24 months was .66 cases per100 person years among men who were circumcised and 1.33 cases per 100 personyears among men who delayed circumcision for 24 months, with an estimated efficacyof 51%. (Gray et al., 2007). (Gray II) (male circumcision, Uganda)2. Male circumcision at birth can reduce HIV incidence for both men and women whencircumcised boys become sexually active. [See Chapter 9C-1. Safe Motherhood and Preventionof Vertical Transmission: Testing and Counseling]Gaps in Programming—Male Circumcision1. Programs must continue to promote protective behavior such as condom use inaddition to male circumcision.1. Programs must continue to promote protective behavior such as condom use in addition tomale circumcision. Studies found that male circumcision is only partially effective, makingprotective behavior such as partner reduction and condom use, in addition to circumcision,essential. Men who have been circumcised can still transmit HIV to women if theyare HIV-positive. Until healing is complete following circumcision, men are more likely toWHAT WORKS FOR WOMEN AND GIRLS69