Male circumcision and HIV in Zambia

Abstract

Background: Over the last 10 years considerable interest has developed in male circumcision as a possible tool in reducing HIV transmission in high prevalence countries of sub-Saharan Africa. Statements from normative agencies, though cautious, have encouraged the introduction of safe hospital based circumcision practice where the demand for these services exists¹. The anecdotal evidence has now been followed by one randomized control trial. The results of two further trials are awaited. In the interim , interest has grown in the question of how male circumcision can be operationalised in a real clinical setting should the two ongoing trials confirm the efficacy of male circumcision.

Methods: The University Teaching Hospital Lusaka has been running an integrated dedicated male circumcision service for the last 2years. This site is, as far as we know, the only dedicated public service male circumcision service site in the region.

Results: The site has performed 900 male circumcisions. The lessons learnt in relation to administration, cost, techniques, key operator and outcomes are reviewed. Comparison is drawn with the three research sites and public health strategies to reduce HIV transmission. Some conclusions are drawn about possible paths and pitfalls for future sites in the region.