While researchers and advocates at the International AIDS Conference this week urged donors and governments to rapidly scale up male circumcision programmes, others raised concerns about what this would mean for women.

In March 2007, the World Health Organisation and UNAIDS issued recommendations that gave the green light to male circumcision as an HIV prevention strategy, after studies in Kisumu, Kenya and the township of Orange Farm in South Africa showed that it could reduce the risk of infection by up to 60 percent.

But the recommendations also stressed that not enough is known about whether male circumcision reduces sexual transmission of HIV from men to women, making the intervention "highly problematic" according to Marge Berer, editor of the London-based journal Reproductive Health Matters. "From a public health perspective, we are told that 60 percent protection [for circumcised men] is far better than nothing. But is male circumcision good enough for women?" she wondered.

A study of almost 3,000 men between the ages of 18 and 24 in Kenya, compared sexual function between circumcised and uncircumcised men, assessing sexual satisfaction over a two-year period. The researchers found that the circumcised group had no higher rates of sexual dysfunction than the uncircumcised men.

According to John Krieger of the University of Washington, Seattle the men that had been circumcised reported more sexual pleasure post-circumcision, and that they found condoms easier to use.
In addition, new results from a male circumcision initiative implemented by Population Services International in Zambia suggest that cultural resistance may not pose as serious a barrier as previously thought, and that it is possible to do the procedures safely and effectively in poor settings, using nurses and clinical officers.

Delegates heard that circumcision also lowers the risk of men getting the human papilloma virus (HPV) that causes genital warts, and trichomoniasis, another common sexually transmitted disease.

What about women?

"All I'm hearing [at the conference] is about what it will do for men, the sexual satisfaction of men...but what about the women? What is their involvement?" commented Siphiwe Hlope, a founder of Swazis for Positive Living (SWAPOL), an AIDS support organisation.

Nicolai Lohse a research officer at UNAIDS said mathematical modelling showed women would benefit from male circumcision as long as it did not result in condom use dropping by more than two-thirds. Women's risk of acquiring HIV would also be reduced if circumcision programmes led to fewer HIV-positive men in the population. The risk to women of HIV acquisition would decline by 2 percent if only 5 percent of men were circumcised, and by 20 percent if half the men in a population were circumcised.

While Berer told delegates on Thursday that the potential benefits of male circumcision were "too large a gamble" for women, many countries in Southern Africa are already in the process of developing national policies on the procedure.
"We have to support these programmes, I don't think we have a choice. But one would really argue that these programmes have a responsibility to women," Berer told IRIN/PlusNews.

She called for campaigns expanding male circumcision to involve couples and not to focus solely on men. Women health advocates also had a role to play in drafting national policies. "No one is going to pull out the red carpet for women's involvement in male circumcision ...it is up to women to stop being victims," Berer added.

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