Goosby: The X factor in circumcision? Sex

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Dr. Eric Goosby, US Global AIDS Coordinator

The response to male circumcision initiatives in eastern and southern Africa has gone much better than experts predicted.

Eric Goosby, MD, the U.S. Global AIDS Coordinator, said today that men obviously want to be circumcised because it is a protective factor against contracting HIV, but he said there also was a powerful X factor:

Sex.

Women, he said, have been telling men to get circumcised.

“The big (motivator) has been the woman partner saying, `I will have more sex with you. It’s cleaner. It’s more enjoyable. I’m more willing to have sex,’’’ Goosby said in a roundtable interview with a handful of reporters Wednesday. “It’s been the partners who have pushed the male in. The men are coming in large numbers and willing to wait hours to have the procedure done.’’

Goosby said the high level of interest took most experts by surprise.

Three randomized control trials in sub-Saharan Africa of adult male circumcision found that medically performed circumcision significantly reduces a man’s risk of acquiring HIV through heterosexual intercourse by as much as 60 percent, which is potentially equivalent to a vaccine.

“When everybody read these studies that came in, the methology was high-quality, done by people we’ve all known for years, hard to argue with,’’ he said.

“But none of us thought that there would be a receptivity in the male community to come in and put your penis on the table and have your skin cut off of it,’’ he said.

Reporters started laughing at Goosby’s choice of words. “Oh, yeah, I probably shouldn’t have said that,’’ he said, laughing as well.

But he said that he and others in the global AIDS fight have been “humbled by the interest and how it has spread’’ among men to be circumcised.

According to the U.S. President’s Emergency Plan for AIDS Relief, if 14 African high-burden countries scaled up male circumcision to reach 80 percent of adult and newborn males in the next five years, it could prevent more than 4 million adult HIV infections in the next 15 years. Such a scale-up also could save $20.2 billion from an overall investment of $4 billion.

Next month, Swaziland will start a national program to circumcise between 125,000 and 175,000 males 15 to 49 years old in a one-year period. Mathematical modeling studies suggest that would prevent 88,000 new adult HIV infections through 2025, and reduce annual HIV incidence by 75 percent by 2025.

Goosby said the program in Swaziland has been helped immeasurably by the support of King Mswati III, who is best known internationally for his practice of polygamy. He currently has 14 wives and 23 children.

At the briefing, a reporter asked Goosby if the Swazi King has been circumcised.

Goosby, who is leaving for Swaziland on Thursday, laughed.

“I don’t know,’’ he said. “I’ll make sure I check.’’

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