Introduction
The issue of the HIV epidemic, unfortunately, remains in different countries as the disease continues to spread. To save as many people as possible, medical professionals implement a number of different methods that have advantages and disadvantages. This paper will focus on analysing the article by Kahn, Marseille, and Auvert, “Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting”. These researchers studied male circumcision (MC) as an intervention method and investigated the effectiveness of such an intervention among adult male patients. According to the World Health Organization (2018, p. 7), “male circumcision has been performed on adolescent boys and men for many years, primarily for religious and cultural reasons, such as a rite of passage to mark the transition to adulthood”. However, recently MC has been acknowledged as a reliable prevention measure.
The primary purpose of this study is to determine the cost-effectiveness of the use of circumcision and if this practice is appropriate. The authors believe that MC is effective in solving multiple problems, such as disease prevention and reducing healthcare costs. This research can be considered valuable and relevant since the demand for prevention intensifies. For this reason, it is vital to recognise productive methods to reduce the spread.
Interventions Strategies
First of all, it is essential to identify what can be categorised as an intervention. According to Krishnaratne et al. (2016, p. 317), intervention is a practice that “seeks to increase demand for HIV prevention, improve the supply of HIV prevention methods, support adherence to prevention behaviours, or directly prevent HIV”. Researchers are aware of different intervention methods, and they take them into account in their study. However, as they note, most prevention strategies “lack confirmatory evidence of reduced HIV incidence” (Kahn et al., 2006, p. 2350). For example, sex worker programs apply to a particularly small group of people. Moreover, it does not fully solve the problem since many makes get HIV from their partners. Vaccines seem like the best option, but the possibility of creating them is unlikely in South Africa. That is why scientists are sceptical about behavioural based methods and consider biological interventions the best option.
On the other hand, some studies suggest other practices that can be implemented. For example, Wechsberg et al. (2016, p. 308) suggest a couples-based intervention, which “focuses on engaging couples together and reducing intersecting risks for HIV to improve biobehavioural outcomes”. However, the researchers insist that circumcision is the best option when it comes to preventing HIV in South Africa since there has been variable acceptance and uptake of MC (Parkhurst, Chilongozi, & Hutchinson 2015). One of the critical advantages of male circumcision is that despite being a one-time intervention, the operation has a long-lasting effect. Moreover, another benefit of MC is the subsequent reduction of infections in women. In other words, HIV becomes less prevalent among women and uncircumcised men. This chain reaction can significantly decrease the spread of the disease.
Method
The researchers evaluated cost-effectiveness for 1,000 circumcised South African male patients who are older than 18 years. Their calculations included the expenses for “performing the circumcisions, providing community publicity, and treating adverse events” (Kahn et al. 2006, p. 2350). The decrease of HIV over 20 years was considered effective. This period was chosen because such duration demonstrates the long-lasting impacts of male circumcision not only on male patients but on the epidemic as well. Moreover, the analysis takes into account the viewpoint of a South African patient who pays for healthcare procedures.
Costs
It is worth noting that researchers included all medical costs in the discussion. For instance, the study states that to get a circumcision an average adult male would have to spend $47, which is considered average (Kahn et al. 2006, p. 2351). This payment includes all expenditures that are necessary for the procedure, such as supplies, salaries for involved medical workers. Besides, it is crucial to remember that researchers did not include the costs of additional training and development of the infrastructure. Apart from their investigation scientists considered other studies and clinical data in South Africa. It helped them to evaluate the lifetime cost of HIV treatment, which amounts to $3,793 at minimum (Kahn et al. 2006, p. 2352). Such information allowed them to compare the costs of curing HIV and MC as a preventive intervention.
Outcomes
One of the key factors of this study is the difference in sexual behaviour of circumcised and uncircumcised men. The research suggests that Kenyan men who did not go through the MC did not act differently from those who experienced MC (Kahn et al. 2006, p. 2352). However, a similar study in Uganda demonstrated contradicting results, telling that circumcised men are more likely to engage in sexual contact at an earlier age than uncircumcised men.
Furthermore, the trial shows that the death rate of men with MC is low. It can be explained by the fact that the prevalence of negative effects after surgery was 3.8% (Kahn et al. 2006, p. 2351). Such complications can vary from pain to “excessive bleeding, infection, damage to the penis, swelling or hematoma, anaesthesia-related events, excessive skin removed, insufficient skin removed, delayed wound healing, problems with urinating, and problems with appearance” (Kahn et al. 2006, p. 2351). Similar problems may occur in cases of medical unprofessionalism; however, they can be treated by a quick visit to another doctor and maybe even a short hospitalisation. In addition, the researchers assume that over 20 years, the 1,000 circumcised men can help to avoid 427 additional HIV infections (Kahn et al. 2006, p. 2353). Such a conclusion is drawn from several factors, including the protective effect of the MC, the reduced risk of sexual behavioural issues, and a decrease in the spread. This data makes the researchers conclude that while the population of South Africa is at high risk of getting HIV infection, adult MC is an appropriate measure.
Interpretation of the Findings
In conclusion, it would appear that the study and report seem to be thoughtfully done, and the results demonstrate the cost-effectiveness of male circumcision. The researchers gathered all necessary information, made calculations to prove that MC makes health system costs significantly lower. Such outcomes are justified by the combination of relatively cheap implementation costs and substantial beneficial effects. After all, avoiding the disease not only seems easier but also cheaper than the treatment. Moreover, such practice is feasible in a clinical setting because of its affordability. As long as the government provides such medical programs, while also ensuring the high quality of service, MC “could contribute significantly to reducing HIV transmission in Southern Africa” (Kahn et al. 2006, p. 2357). Therefore, it can be suspected that patients may benefit from undergoing such a procedure, although the reasons for going through circumcision are primarily cultural. For this particular reason, adult male circumcision can rightfully be considered cost-effective.
Reference List
Kahn, J.G., Marseille, E. & Auvert, B., 2006, ‘Cost-effectiveness of male circumcision for HIV prevention in a South African setting’, PLoS Medicine, vol. 3, no.12, pp. 2349-2358.
Krishnaratne, S., Hensen, B., Cordes, J., Enstone, J. & Hargreaves, J.R., 2016, ‘Interventions to strengthen the HIV prevention cascade: a systematic review of reviews’, The Lancet HIV, vol. 3, no. 7, pp. 307-317.
Parkhurst, J.O., Chilongozi, D. & Hutchinson, E., 2015, ‘Doubt, defiance, and identity: understanding resistance to male circumcision for HIV prevention in Malawi’, Social Science & Medicine, vol. 135, pp. 15-22.
World Health Organization, 2018, Male circumcision for HIV prevention: manual for male circumcision under local anaesthesia and HIV prevention services for adolescent boys and men. Web.
Wechsberg, W.M., Zule, W.A., El-Bassel, N., Doherty, I.A., Minnis, A.M., Novak, S.D., Myers, B. & Carney, T., 2016, ‘The male factor: Outcomes from a cluster-randomized field experiment with a couples-based HIV prevention intervention in a South African township’, Drug and Alcohol Dependence, vol. 161, pp. 307-315.