Re: The dilemma of circumcision for Hindus. DFID Statement to Male Circumcision

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DFID Statement to Male Circumcision

DFID Statement to Male Circumcision Meeting - Male Circumcision

Policy Meeting, March 6 -8, Montreux, Switzerland

1. The UK Department for International Development is committed

to promoting the availability and use of a comprehensive range of

evidence based methods for STI and HIV prevention for all men, women

and young people – including particularly vulnerable groups such as

men who have sex with men, adolescent girls, sex workers and drug

users.

2. The research to date on male circumcision is welcomed. Three

randomised control trials, all demonstrating consistent results,

leave us in no doubt that there is a strong protective effect for men

of male circumcision. However, key questions remain unanswered. For

example, will male circumcision make women less or more vulnerable to

HIV infection? Wawer's presentation on the male to female

transmission study highlights this urgency. What will be the impact

of male circumcision on condom use? Will women's ability to negotiate

condom use with their circumcised male partners be further limited?

And at what level would reduced condom use negate the protective

effects of male circumcision?

3. As the level of debate at this meeting has demonstrated, the

transition from having new evidence, however robust, to introduction

and scale up of a new prevention method is very challenging. In doing

so we cannot and must not separate the issue of male circumcision

from the complex range of social, cultural and political issues that

determine sexual and reproductive behaviour, health and rights. There

are three key issues that DFID would particularly like to highlight:

a. Firstly, the gender dimensions of male circumcision must be

considered. For example, community and religious leaders must have a

clear understanding of the enormous differences between male

circumcision and female genital mutilation. We need to listen to

concerns that men may have about stigma and sexual expression. And we

must further our understanding of the impact of male circumcision on

women's vulnerability to HIV, STIs and unwanted pregnancy.

b. Secondly, the need to include messages about male

circumcision within processes and programmes that promote a

comprehensive menu of prevention methods. In particular, new efforts

to scale up access to male circumcision must not in any way detract

from other prevention options and should strengthen access to and use

of male and female condoms – currently the most effective prevention

method available.

c. Thirdly, scaling up male circumcision must be as part of

efforts to strengthen primary health services including efforts to

strengthen male and female SRH services and ensuring these are

central to the AIDS response. This must not be a vertical programme.

In conclusion, while welcoming the additional evidence-based

prevention method that male circumcision provides, DFID urges

caution. Single minded pursuit of a new technology is not what is

needed. The way forward must take account of the context, including

the gender dimensions, in which peoples' sexual relationships and

behaviour is defined; the need to improve access to a comprehensive

range of prevention methods and the importance of strengthening

delivery of health services to achieve progress in all of the health

MDGs.