The combined use of circumcision in men and anti-retrovirals (ARVs) therapy has decreased in the number of new HIV infections by over 42 per cent in Rakai district, findings of a new study reveal.
According to the findings that were released by the Rakai Health Sciences Program at the Serena hotel in Kampala, the combined use of both circumcision and the constant use of ARVs can reduce the rate of new infections in both men and women by 42%.
Professor David Serwadda, says the findings are proof that combined methods of prevention are effective.
"Rakai has been able, over a period of 17 years, to actually look at what the number of new infections were before combination prevention was started. That is the period before 2004 and the period after 2004 - which is about 11 years to last year.
When you combine those two incidents of number of new infections before and after, we see that after about 45 years of actually introducing combination prevention, we’re seeing a reduction of up to 40 per cent of new cases than we’d have seen before in men and women", said Prof Serwadda.
The study findings reveal that the number of new HIV infections have continued to drop since the introduction of combined preventive techniques in Rakai in 1999. New infections were stable at 12 cases per 1,000 persons per year in the year prior to the introduction of combined HIV prevention in 1999.
Seventeen years after introduction of combined HIV prevention methods, however, the rate of new infections has dropped and has been stable for the last two years (2014-2016) at 6.6 cases per 1,000 persons.
Prof Serwadda says that the reduction in men is much greater than that of women. The reduction rates stand at 54% and 32% in men and women respectively because they benefit from two preventive methods.
"We see that the reduction in new infections is much greater in men compared to women. The reduction we see in men is about 54 per cent compared to the reduction we see overall of 32 per cent in women.
The reason why we see the difference, is because, men are benefiting from the protective effect of circumcision to HIV acquisition and at the same time because more women are on treatment compared to men - ART therefore they have less viruses in their blood it reduces their chances of acquisition of HIV from women. That is why we see a bigger impact", Prof Serwadda added.
Serwadda says the results point to the fact that combination prevention of HIV is much more effective than when a single method of prevention is used.
"We have noticed that the circumcised men benefit from direct protective effect of circumcision as well as from indirect effect of female partners who are using ART."
He says there's still more work that needs to be done before they can reach a level of totally eliminating HIV from Rakai, the area where the first case of HIV was recorded 30 years ago.
Dr Joshua Musinguzi, head of the AIDS Control Program at the ministry of health, says that the findings from Rakai are welcome and will be considered as they roll out to target men in HIV prevention.
"The findings show that if more men are involved in the prevention of HIV, it can have long lasting effects on society. We are currently targeting men and one method we shall use is promoting circumcision because the findings here reveal that if men are circumcised and women are on ARVs we can curb new HIV infections," he said.
A total of 33,937 people from 30 communities in Rakai are estimated to have participated in the study that began in 1999 and ended last year. The study was an open population base study where people were left in their communities during the 17-year duration.
According to Prof Serwadda, the study was carried out in Rakai because it is one of the first areas in the country where HIV was established in the district at Kasensero landing site in the 1980s. The HIV prevalence rate in the district stands at 12%.