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Circumcising newborns to prevent HIV

Circumcision as a way to prevent HIV emerged as a hot topic in 2007, when the first large-scale studies from Africa showed it could reduce infection rates by about 55 percent. I remember seeing former President Bill Clinton stand before the International AIDS Conference in Toronto in 2006, when preliminary results on these studies were reported, touting the value of circumcision as a new prevention tool. Still, he cautioned that cultural practices, the availability of sterile facilities and costs all could be limiting factors in the use of the procedure, which is now recommended by the World Health Organization.

Now a new study out of Rwanda suggests that the most cost-effective approach is to circumcise newborns, rather than adolescents or adults. The study, published this week in PLoS Medicine, found that circumcising boys just after birth costs just $15 per child, compared to $59 for an adult or adolescent. Moreover, circumcision after birth is quick and easy and rarely produces complications, whereas complications, particularly infections, are more common in adolescents and adults, the writers note.

“Given the low cost and long-term benefits, this study suggests that countries with moderate HIV epidemics should offer routine infant circumcision, integrated into existing health services,” the writers conclude.

In Rwanda, male circumcision is not traditionally practiced, and only about 15 percent of men are circumcised, the authors estimate. But because of the ongoing debate about the practice, the Rwandan Ministry of Health reports that the demand for the service is rising. And though Rwanda’s HIV infection rate is relatively low, less than 3 percent, implementation of a national circumcision program could help keep those rates in check. The study collaborators included researchers from the Rwandan Ministry of Health, UNAIDS and UNICEF.

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