WHO/UNAIDS recommendations

The World Health Organization (WHO) and UNAIDS recommended in March 2007 that circumcision programmes should become part of HIV prevention programmes in countries seriously affected by HIV. They warned, however, that circumcision must not be relied upon as the sole means of protection against HIV, that it provides incomplete protection, and that its benefit will not be seen for several years.

Countries with a high HIV prevalence, a low prevalence of circumcision and high rates of heterosexual transmission should consider adopting circumcision as a priority, they said. Many of these are located in southern and eastern Africa. Circumcision for adolescents and young sexually active men should be the priority – it will take 15 to 20 years to see the benefits of circumcision in babies and young children. In order to have a population-level effect, coverage would need to be very high.

Asked whether circumcision should be recommended for all HIV-negative men, not just men in countries with high HIV prevalence, Catherine Hankins of UNAIDS said: “For individual men there can be a real benefit immediately.”

WHO and UNAIDS recommend that circumcision should be provided at no cost or at the lowest possible cost, and that it should be performed by medically trained personnel in order to reduce the risk of complications.

Widespread changes in cultural attitudes would be needed. However, it was important that any changes did not affect the human rights of males, including the right of adolescents to withhold consent.