Experts divided over baby circumcision plan
A controversial plan to circumcise newborn babies is among a string of drastic new proposals to tackle the scourge of HIV.
They are contained in the first draft of the National Strategic Plan for HIV and Aids, STIs and TB launched by the South African National Aids Council (Sanac).
The discussion document, which will become the blueprint for Sanac's fight against the pandemic over the next five years once finalised, will be officially launched on World Aids Day on December 1.
The proposed goals of the new strategy include reducing the rate of new HIV infections by 50% and new HIV infections in children by 90% by 2016.
Other proposals include offering circumcisions to young men before they become sexually active and preventing unintended pregnancies, especially among young girls, through sexual and reproductive health information and education in schools.
In addition, the plan suggests universal HIV testing and TB screening on an annual basis for every South African 12 years and older who previously tested negative or whose test status is unknown.
While medical practitioners this week welcomed plans to circumcise young men before their first sexual encounter, they were sharply divided over the proposal on neonatal circumcisions.
Dr Ashraf Coovadia, a paediatrician at Rahima Moosa Hospital in Gauteng, said encouraging young men to be medically circumcised had been a scientific recommendation for some time.
Studies conducted in Kenya, Uganda and South Africa have shown that there was a reduction of between 50% and 60% in HIV infection among men who had been circumcised.
"The medical fraternity believes it's one of the very good medical, evidence-based options in the prevention of HIV," said Coovadia.
Durban paediatrician Dr Thahir Mitha said scientific evi-dence pointed to the benefits of neonatal circumcision.
"At least 25% to 30% of the country's 700-odd paediatricians support neonatal circumcisions," he said.
But Professor Johan Smit, a neonatologist at Tygerberg Children's Hospital in the Western Cape, said circumcising newborns "was not in the best interests of the child".
"The procedure is not without risks, and newborn circumcision is not based on any scientific evidence. It is based on the extrapolation of scientific data obtained by three studies on adult males.
"It should be left to parents to decide, following counselling, about the risks and benefits of such a procedure."
Gerard Payne, advocacy manager for the Aids Consortium, said they supported medical circumcisions in males as a preventive measure, "but we haven't taken a stance on neonatal circumcisions".
Minister of Health Aaron Motsoaledi said he welcomed the proposal on circumcision, saying studies had proven that it was effective in the prevention of HIV. He also supported neonatal circumcisions and urged neonatologists who took issue with this to raise their concerns.
Writing in the June edition of the South African Journal of Bioethics and Law, YA Vawda and LN Maqutu of the University of KwaZulu-Natal's law department examined the ethical, legal and public health considerations of circumcision of newborns as an HIV-prevention strategy.
They concluded that the public health hazard of HIV and Aids could justify such a move.
According to the Sanac document, key sectors of the population that should be targeted for prevention, care and treatment interventions include young girls, men having sex with men, and mobile and migrant populations such as truck drivers and mine and construction workers.
It also advocates distributing condoms at taverns and shebeens, and preventing mother-to-child transmission by increasing testing of pregnant women and providing treatment.