Marseille 2007
| Abstract #334 - Managing Male Circumcision for HIV Prevention: Experiences and Expertise from the Holy Land | ||||
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Session: 28.4: Religion and traditional practices (Parallel) on Tuesday @ 11.00-12.30 in 5 Chaired by Veronica Noseda, Herve Richaud Authors: Presenting Author: Dr Inon Schenker - The Jerusalem AIDS Project , Israel |
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| Aim: Countries in Africa most affected by HIV/AIDS face a new challenge in prevention: integrating male circumcision (MC) into existing national and community HIV prevention packages and services. Managing large-scale services which could provide the MC operation for young adults or infants has not yet been documented. Very few countries have meaningful experience with hospital/clinic-based MC for adults. This is the first description of a decade long experience in Israel. The paper will present a road-map for MC technology transfer to Africa, in view of current challenges in scalling up or rolling out MC services for HIV prevention. | ||||
| Method / Issue: Male Circumcision is now a proven intervention which reduces the probability of transmission of HIV from infected women to men by up to 60%. Three controlled trials (in South Africa, Kenya and Uganda) provided this evidence when researching large samples of young men in Africa. Countries most affected by HIV/AIDS need now to develop evidence-based policies, programs and training; and be guided by the international community how to either scale-up or role-out male circumcision services. Decisions on age in which MC is to performed, who will be authorized to perform it, where would the operation be conducted, how and where training be managed and who will pay for the intervention - are just a few of the considerations countries are faced with today. Building on lessons learned from other countries is central to the discussions at national, regional and international levels. Israel presents important experiences and expertise managing both infant and adult MC on a very large scale. | ||||
| Results / Comments: From 1998 to 2006, 11,245 MC operations were performed in Israel on adults (age range 6M-94Y). These well documented hospital/clinic-based operations are a fraction of over 50,000 estimated MC in Israel performed on adults- mostly newly arriving (Jewish) immigrants from Eastern Europe and Ethiopia- between 1989 to date. Additionally, over 52,000 Jewish, Muslim and Christian infants are circumcised traditionally in Israel every year. This is a unique and most impressive experience in a developed country. The Jerusalem AIDS Project is a national focal point on MC and HIV/AIDS. In November 2006 we held a national consultation on MC under local anesthesia in collaboration with WHO, to support the review process of the UNAIDS/WHO/JEPIEGO manual on the subject. | ||||
| Discussion: Management models of massive adult MC in Israel could be at the service of African countries needing to address the new promising opportunity of a life-saving intervention for HIV prevention. The Israeli experience - presented for the first time in this paper - provides guidance on training and supervision of both traditional and medical circumcisers, criteria for authorizing facilities, surgical and anesthesia practices, monitoring complications and national policies developed to maintain a religious (Jewish and Muslim) ritual under safe and sound medical parameters. | ||||
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