Published: Saturday 14th October 2017
Summary: Expanding access to voluntary medical male circumcision in Africa may help protect women against HIV and sexually transmitted infections.
Expanding access to voluntary medical male circumcision (VMMC) in sub-Saharan Africa may help protect women against not only HIV but other sexually transmitted infections, a literature review published October 9 in The Lancet Global Health shows.
Researchers from the U.S. Centers for Disease Control and Prevention (CDC), Jhpiego and the Johns Hopkins Bloomberg School of Public Health analyzed 60 publications, and found they consistently showed evidence that male circumcision is associated with decreased risk for cervical cancer and its precursor cervical dysplasia, herpes simplex virus type 2 (the main cause of genital herpes), chlamydia, and syphilis in women. They also found additional evidence that male circumcision is associated with decreased risk for human papillomavirus, which causes cervical cancer and genital warts. Researchers conducted the analysis to understand the association of male circumcision with women's health outcomes based on the available data.
Voluntary medical male circumcision, an effective HIV prevention being scaled up across Eastern and Southern Africa in accordance with World Health Organization (WHO) and UNAIDS guidance, has been shown to reduce men's risk of heterosexually-acquiring HIV and some sexually transmitted infections.
While past studies have shown that the intervention helps decrease women's risk for HIV and cervical cancer, it has not been clear how this male-focused strategy impacts women's health. This new consolidation of evidence suggests that VMMC may have beneficial effects for women beyond HIV, in some of the highest-priority diseases in global women's health.
"These findings confirm that voluntary medical male circumcision is associated with protection for female partners from diseases that severely impact their health," said study first author Jonathan Grund, M.A., M.P.H., of CDC's Division of Global HIV & TB. "Existing prenatal care services and cervical cancer screening programs already counsel women about staying healthy. If that counseling includes encouraging male partners to get circumcised and referring interested men to these services, it can improve women's health programs and HIV prevention programs simultaneously." A next step would be confirming that these findings are also seen in the existing international circumcision program over time, and monitoring their impact.
Cervical cancer is the second most common cancer among women living in developing countries and a leading cause of death among women living with HIV, while some sexually transmitted infections can cause stillbirth.
Nearly 15 million adult and adolescent males chose to have VMMC between 2007 and 2016, with the majority of these procedures being supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in partnership with local Ministries of Health and Defense.
The article's authors recommend that strengthening linkages and cooperation between VMMC and women's health programs be explored, to ensure that the benefits of male circumcision for women's health are fully optimized.
Jhpiego, with the support of PEPFAR, is a leader in scaling up comprehensive HIV prevention services, working with the United States Agency for International Development, U.S. Department of Defense, and CDC to ensure men have access to quality VMMC services.
In addition to HIV prevention, the WHO's highest priorities for women's health include prevention and treatment of sexually transmitted infections and screening and prevention of cervical cancer, areas to which male circumcision on this scale could contribute. Sexually transmitted infections like herpes and syphilis are also passed from mothers to their infants and can cause infant death and stillbirth.
"Increasing access to high quality medical male circumcision services has been one of our most profound contributions to preventing the spread of HIV," said Kelly Curran, a study co-author from Jhpiego, a global health nonprofit and Johns Hopkins University affiliate. "This study reminds us that those efforts can contribute to positive health outcomes for others well beyond our immediate beneficiaries and accelerate achievement of several Sustainable Development Goals."
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