Thanks to better access to antiretrovirals and the promotion of voluntary circumcision in Africa, the rate of new infections is falling. A Ugandan study proves it again.
Large-scale voluntary male circumcision programs in Africa, and increasing access to antiretroviral therapy, have helped reduce HIV infections in rural communities in Uganda, suggests a study published this Tuesday in the journal JAMA.
For 3 decades, the protection conferred by male circumcision against HIV has been demonstrated by studies carried out in Africa. The rate of new infections in circumcised men can in fact be reduced by up to 60% compared to the uncircumcised, even though sexual behavior (use of condoms, number of partners) is the same in these individuals.
Convinced of its effectiveness, the World Health Organization (WHO) and the Joint United Nations Program on HIV / AIDS (UNAIDS) recommend the integration of male circumcision into African programs to fight HIV infection. since 2007.
A study of 45,000 people
Recent work by the Johns Hopkins Bloomberg School of Public Health confirms the benefits of this method, as well as the use of antiretrovirals in prevention, in real life conditions.
“The biology of these two prevention strategies were proven, but the big question was whether they would impact new infections in communities that still struggle to control the spread of HIV,” says Xiangrong Kong, head of HIV. works.
To find out, Dr Kong and his colleagues followed nearly 45,000 people living in the rural district of Rakai in Uganda between 1999 and 2013. The researchers collected data on the use of antiretrovirals, the use of circumcision, sexual behavior, living conditions and the rate of new infections.
Their analysis focused on 3 distinct periods: before access to medicines and medical circumcision (1999-2004), at the launch of these prevention programs (2004-2007) then once these programs have been assimilated by the population ( 2007-2013).
In 14 years, researchers have seen the use of circumcision increased from 19% to 39%. The use of prevention drugs has also increased among men and women, going from 0 to over 20%.
The need for financial support
The study shows that in communities where 40% of men were circumcised, the rate of new infections fell by more than a third, compared to the group where less than 10% of men opted for this method of prevention.
In addition, it highlights the protection provided by antiretrovirals. In communities where more than 20% of HIV-positive women have access to drugs, new transmissions have fallen by 23% among men. In contrast, no reduction was observed in women. But these effects will be observed as soon as the use of these treatments increases in men, underlines Xiangrong Kong.
“We still have a long way to go before we bring the HIV epidemic in Africa under control,” she says. People must adopt these strategies and we need sustainable financial support to do so ”.
In sub-Saharan Africa, 25.8 million are living with HIV. In 2014, about 40% of patients had access to treatment, and more than 10 million men decided to be circumcised, according to the WHO.
.
