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Scarification and Male Circumcision Associated with HIV Infection in Children

Dr Devon Brewer has just published a paper on the role of scarification and male circumcision in transmitting HIV in Mozambican children and youth. The findings suggest that there is little difference in transmission whether the circumcision is performed by a traditional circumciser or a medically qualified professional. This may help shed light on the question of why “16-20% of HIV infected children had seronegative mothers” in surveys carried out in Swaziland and Uganda.

HIV transmission is not particularly closely correlated with sexual behavior in African countries but many children infected with HIV are not even sexually active (nor are quite a number of adolescents and adults). Considering the current popularity of mass male circumcision as a means of reducing HIV, and the millions of dollars being thrown at it, these findings deserve to be investigated, not just dismissed by UNAIDS and the HIV industry in general.

Scarification may be common in some countries, including countries with high prevalence of HIV and other blood borne diseases. So far, little research has been carried out into the possible contribution of scarification to HIV epidemics.

Brewer finds that “circumcised and scarified children and youth were two to three times more likely to be infected with HIV than children and youth who had not been circumcised or scarified, respectively”. He further remarks that these phenomena could only account for a relatively small fraction of horizontally acquired HIV infections in these groups. Therefore, other blood exposures, such as unsafe healthcare, probably account for the rest.

While standards of hygiene may be higher in clinical settings than in traditional settings, medical circumcision may involve more risky procedures, such as anesthetic injections and suturing. Also, health facilities may have a tendency to concentrate blood-borne and other pathogens, given that people who are sick attend these facilities, if possible.

There is plenty of research showing that medical facilities in African countries are ill-equipped to control infections that are spread as a result of medical procedures. Kenya, Uganda, Tanzania and other countries already carrying out mass male circumcision campaigns, along with those planning to do so, would do well to ensure that they don’t risk doing more harm than good.

It would have been preferable to carry out a thorough investigation before rolling out such campaigns because it’s difficult to interrupt something that has already gone so far and attracted and spent so much money. Perhaps this finding about male circumcision could be compared to the even longer running and far more widespread contraception campaigns, which may also have exposed people to risks of HIV transmission.

As Brewer concludes, “To determine modes of HIV transmission with confidence, researchers must employ more rigorous research designs than have been used to date in sub-Saharan Africa. Such designs involve assessing blood and sexual exposures comprehensively in incident HIV cases and controls, tracing their contacts corresponding to these exposures, and sequencing infected person’s HIV isolates. In the meantime, Mozambicans and other Africans should be warned about all risks of blood-borne HIV transmission, including scarification and medical and traditional circumcision, and informed about how these risks can be avoided”.

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