A new paper published in The Lancet Global Health suggests that greater access to voluntary medical male circumcision (VMMC) for men in sub-Saharan Africa has put women at lower risk for a range of sexually transmitted diseases.
The World Health Organization (WHO) touts male circumcision as an important protective measure for reducing the risk of heterosexually-acquired HIV infection in men by about 60%. In parts of the world with high rates of HIV and low prevalence of circumcision, health officials promote circumcision as part of their HIV prevention strategy. According to a progress brief published by WHO earlier this year, there have been more than 14.5 million VMMCs in 14 countries since the health agency and the Joint United Nations Programme on HIV/AIDS (UNAIDS) began a campaign in 2007 in sub-Saharan Africa encouraging more men to get circumcised. UNAIDS has set a goal to circumcise 90% of men between the ages of 15 and 29 years in priority countries in eastern and southern Africa by 2021. It’s estimated that the program will prevent nearly half a million new HIV infections through 2030. Men getting a VMMC also receive access to safe sex education, condom education and provision, sexually transmitted infection management, and HIV testing.
While the benefits of circumcision often focus on men’s health, a recently published literature review conducted by researchers from the Centers for Disease Control and Prevention, the Johns Hopkins Bloomberg School of Public Health, and the global health nonprofit Jhpiego, highlights the benefits of the procedure for women. In their recommendation for the VMMC program, WHO and UNAIDS could have positive direct and indirect health benefits for women, decreasing men’s infectiousness of sexually transmitted infections, and thus, women’s exposure to infected partners. The paper’s authors looked at 60 publications going back more than a decade up to April 11, 2016, with their search including peer-reviewed and grey literature publications on the associations between male circumcision and women’s health outcomes.
The authors found high-consistency evidence that male circumcision protects women against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. They also found studies linking male circumcision with protecting women against human papillomavirus and low-risk human papillomavirus. In addition, they found evidence showing a protective association with HIV, though one trial indicated there was an increased risk to female partners of HIV-infected men who resumed sex soon after male circumcision.
“Increasing access to high quality medical male circumcision services has been one of our most profound contributions to preventing the spread of HIV,” said study co-author Jhpiego’s Kelly Curran in an article from Johns Hopkins University. “This study reminds us that those efforts can contribute to positive health outcomes for others well beyond our immediate beneficiaries.”
With the historic scale-up of VMMC over the last decade, the authors concluded that there is substantial evidence that the effort has relevance to women’s health programs, calling for more research on the impact of circumcision on women’s health, along with pregnancy and neonatal outcomes. “These findings confirm that voluntary medical male circumcision is associated with protection for female partners from diseases that severely impact their health,” said first author Jonathan Grund, MPH. “Existing prenatal care services and cervical cancer screening programs already counsel women about staying healthy. If that counseling includes encouraging male partners to get circumcised and referring interested men to these services, it can improve women’s health programs and HIV prevention programs simultaneously.”
By Einav Keet