{"id":174,"date":"2007-05-13T03:46:46","date_gmt":"2007-05-13T08:46:46","guid":{"rendered":"http:\/\/blogs.law.harvard.edu\/politicshiv\/2007\/05\/13\/male-circumcision-as-foreign-poli"},"modified":"2007-05-14T00:15:12","modified_gmt":"2007-05-14T05:15:12","slug":"male-circumcision-as-foreign-policy","status":"publish","type":"post","link":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/2007\/05\/13\/male-circumcision-as-foreign-policy\/","title":{"rendered":"Male circumcision as foreign policy"},"content":{"rendered":"<p>The Council on Foreign Relations held its <a href=\"http:\/\/thdblog.wordpress.com\/2007\/04\/29\/new-health-technologies-in-foreign-aid\/\">first of several rounds<\/a> on the role of health technologies in US foreign policy.  Laurie Garrett led the discussion with Ambassador Mark Dybul and New York Health Commissioner Tom Frieden.  The full video is available on the <a href=\"http:\/\/www.cfr.org\/publication\/13244\/cfr_live_webcast.html\">CFR site<\/a>.  I&#8217;d be curious to hear what others think but I came away with the general sense that Dybul and by extension the PEPFAR program is overly cautious about male circumcision as HIV prevention.  Several times Dybul pointed to slides (which hopefully the CFR video editor will post&#8230;) with WHO models that showed the HIV epidemic would not end with MC alone.  Although Dybul did not mention the WHO authors, but he may have been referring to the <a href=\"http:\/\/medicine.plosjournals.org\/perlserv\/?request=get-document&amp;doi=10.1371\/journal.pmed.0030262\">Williams et al PLoS study<\/a> published in July 2006.  While not predicting the end of the epidemic, Williams et al did find that:<\/p>\n<blockquote><p>MC could avert 2.0 (1.1-3.8) million new HIV infections and 0.3 (0.1-0.5) million deaths over the next ten years in sub-Saharan Africa.  In the ten years after that, it could avert a further 3.7 (1.9-7.5) million new HIV infections and 2.7 (1.5-5.3) million deaths, with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa.<\/p><\/blockquote>\n<p>Circumcision, like any STI control strategy, works when core spreaders at the nodes of the sexual networks are treated.  There are no guarantees that high risk individuals will seek out the knife or that if they did, once cut, their new circumcised status would not affect decisions about high risk sex.  But national policies to circumcise adolescents and infants, calling for safely deployed and closely monitored programs as with any public health intervention, promise to shift the epidemic curve over a few short years.  New cohorts of young circumcised men, exposed to the same safe sex messages currently broadcast and presented with the same level of condom social marketing as now, will be at fundamental lower risk of HIV infection.  That sounds like a worthy effort for US taxpayers to fund, certainly more than the $15 million currently available from an annual PEPFAR budget in the neighborhood of $3 billion.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Council on Foreign Relations held its first of several rounds on the role of health technologies in US foreign policy. Laurie Garrett led the discussion with Ambassador Mark Dybul and New York Health Commissioner Tom Frieden. The full video is available on the CFR site. I&#8217;d be curious to hear what others think but [&hellip;]<\/p>\n","protected":false},"author":712,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1107,1110],"tags":[],"class_list":["post-174","post","type-post","status-publish","format-standard","hentry","category-politics-and-policy","category-science-and-technology"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/posts\/174","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/users\/712"}],"replies":[{"embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/comments?post=174"}],"version-history":[{"count":0,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/posts\/174\/revisions"}],"wp:attachment":[{"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/media?parent=174"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/categories?post=174"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/archive.blogs.harvard.edu\/politicshiv\/wp-json\/wp\/v2\/tags?post=174"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}