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Religion and Male Circumcision for HIV Prevention R. Frank Gillum, MD Howard University College of Medicine Stefan Livingston, MPH M. Haider, PhD University.

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Presentation on theme: "Religion and Male Circumcision for HIV Prevention R. Frank Gillum, MD Howard University College of Medicine Stefan Livingston, MPH M. Haider, PhD University."— Presentation transcript:

1 Religion and Male Circumcision for HIV Prevention R. Frank Gillum, MD Howard University College of Medicine Stefan Livingston, MPH M. Haider, PhD University of Maryland School of Public Health

2 The ABC approach to HIV/AIDS prevention  Abstinence  Be faithful (partner number reduction)  Condoms

3 Is a new C needed in ABC  Circumcision of males –Newborn –Adolescent –Adult

4 Evidence for adult circumcision  In observational studies, circumcised men have lower prevalence of HIV infection than uncircumcised men  In randomized clinical trials in Africa, HIV seroconversion rate over 2 years was reduced by 60% by adult circumcision

5 Results of a meta-analysis of African randomized trials of circumcision (adapted from Mills et al. HIV Medicine 2008)

6 Barriers to widespread adult male circumcision in Africa  Cost  Lack of trained operators/equipment  Pain and discomfort  Cultural factors  Complications  Possible increased risk taking afterwards

7 Should newborn circumicision be promoted in African American high-risk communities?  Cost for ininsured  Infant pain and suffering  Infant human rights  Complications  Other health benefits controversial

8 Religious issues  “Circumcision is a procedure inextricably bound with religion.” Chatterjee  Islam, Judaism, and many traditional/tribal religions mandate male circumcision

9 Religious issues  In Africa, male circumcision is the norm in Islamic populations  Usually performed in adolescents because of indigenous customs  May be performed in infancy or childhood, but must be performed before marriage  HIV prevalence rates are low in Islamic populations

10 Religious issues  Male circumcision as a rite of passage to adulthood is practiced in many African ethnic groups (e.g.W. Dinka, Kikuyu, Maasai, Yoruba, Igbo)  But not in others (e.g. E. Dinka, Lesotho)

11 Religious issues  Among African Christians, only Coptics mandate male circumcision  About 40% of health services are provided by Christian organizations in subsaharan- Africa (higher in rural/lower income areas)  Are faith-based organizations promoting male circumision for HIV prevention?

12 Religious issues  We conducted a preliminary study of a random 20 CCIH member organizations. Websites were reviewed  16 had websites  10 had ministries in Africa and 2 in Haiti  1 made any mention of male circumcision for HIV prevention (Presbyterian USA)

13 Religious issues  Brown and Michemi described church- related male circumcision programs in Kenya in a 2003 ICASA presentation.

14 Church and MC in Kenya Presb yterin 300/yMeru Nov - Jan Surg tech Gosp el VarKalenjinVarTrad Presb ytern 300KikuyuVarBoth Evang1700 Luhyia/K alenjin Aug Nov Trad

15 Religious issues  Three of the four programs included instruction of boys on HIV prevention  Two did large numbers during a boys’ rite of passage retreat during school holidays following primary school completion using physicians or medically trained circumcizers

16 Religious issues  Consultations among FBO’s should address the following questions:  Should FBO’s promote voluntary adult circumcision, rites of passage circumcision, both or neither in Africa or elsewhere?  Are there model programs that can be adapted/replicated?  Should programs have a faith component?

17 Religious issues  Can these barriers be overcome?  Cost  Lack of trained operators/equipment  Pain and discomfort  Cultural factors  Complications  Possible increased risk taking afterwards

18 Religious issues  Unwillingness of churches to be associated with rites associated with indigenous religions and Islam  Preference for Abstinence/Be faithful programs only

19 Religious issues  Conclusions  Involvement of FBOs with male circumcision to prevent HIV transmission is not widespread  FBOs should discern what role male circumcision will play in their response to the HIV/AIDS pandemic in Africa and elsewhere

20 Thank you

21 Number (x 10 4 ) and percent of male newborn infants circumcised in the US,


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