Male circumcision: Implications for women as sexual partners and parents
Male circumcision: Implications for women as sexual partners and parents
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DOI：
10.1016/s0968-8080(07)29311-5
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发表时间：
2007-05-01
影响因子：
--
通讯作者：
Hankins, Catherine
中科院分区：
文献类型：
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作者：
Hankins, Catherine
1986年首次发表的文章表明，男性包皮环切术在预防艾滋病毒方面可能发挥作用，随后20年的观察数据表明，男性包皮环切术与较低艾滋病毒流行率之间存在关联。1,2然而，需要随机对照试验来确定保护作用的水平，确定手术不良事件发生率和记录术后性行为。在莱索托、肯尼亚、马拉维、斯威士兰、坦桑尼亚和赞比亚等国，现在公布的试验为利益攸关方之间的公开辩论开辟了空间，甚至在所有结果都还不知道之前。世卫组织和艾滋病规划署还于2006年11月在内罗毕组织了一次区域协商；3 2006年12月在日内瓦举行的关于男性包皮环切规划的战略和办法的会议；2007年1月在德班举行的关于社会科学观点的会议；5 . 2007年1月在日内瓦举行关于男性包皮环切和青年男子性健康和生殖健康的会议；以及2007年3月在蒙特勒举行的世卫组织/联合国艾滋病规划署关于政策和规划影响的国际磋商会。这些试验的结果在人口水平上对妇女意味着什么？间接地，预计目前生活在艾滋病毒高流行环境中、男性包皮环切率较低的妇女，如果在实现广泛覆盖的规划中，包皮环切的男子的艾滋病毒发病率降低，那么今后10-20年可能会受益。这是因为女性遇到感染艾滋病毒的性伴侣的可能性较低。至于对女性风险的直接影响，Rakai试验中的招募人员试图证实或反驳先前的观察数据，这些数据表明男性包皮环切术对艾滋病毒传播给女性的重要影响。男性包皮环切是否会影响男性向女性性传播艾滋病毒的可能性，可能永远不会知道。本文强调了男性包皮环切试验结果对女性作为性伴侣和父母的一些影响，并讨论了一些与性别有关的问题。
TWENTY years of observational data demon-strating an association between male circumcision and lower HIV prevalence followed the first publications in 1986 suggesting a possible role for male circumcision in HIV prevention. 1, 2 However, randomised, controlled trials were necessary to determine the level of the protective effect, ascertain adverse surgical events rates and document sexual behaviour post-surgery. The now-published trials opened a space for public debate among stakeholders, even before all the results were known, in countries such as Lesotho, Kenya, Malawi, Swaziland, Tanzania and Zambia. WHO and UNAIDS also organised a regional consultation in Nairobi in November 2006; 3 one on strategies and approaches to male circumcision programming in Geneva in December 2006; 4 one on perspectives from social science in Durban in January 2007; 5 a meeting on male circumcision and young men’s sexual and reproductive health in Geneva in January 2007; and the WHO/UNAIDS international consultation on the policy and programming implications in Montreux in March 2007. 6 What do the results of these trials mean at the population level for women? Indirectly, it is anticipated that women currently living in high HIV prevalence settings with low male circumcision prevalence may benefit 10–20 years hence, if there is a reduction in HIV incidence among men who are circumcised in programmes achieving wide coverage. This is because women would have a lower probability of encountering a sexual partner with HIV infection. As for a direct effect on risk for women, recruitment in a Rakai trial looking to confirm or disprove previous observational data suggesting an important effect of male circumcision on HIV transmission to women was stopped; it may never be known whether or not male circumcision affects the probability of sexual transmission of HIV from men to women. 7 This paper highlights some of the implications of the results of the male circumcision trials for women as sexual partners and parents and discusses some gender-related concerns.