POST RESPONSE - REQUEST FOR ASSESSMENT OF FOREIGN POLICY

UNCLAS LILONGWE 000839

SIPDIS

SIPDIS
AIDAC

STATE FOR AF/S KAMANA MATHUR
STATE FOR S/GAC KATIE CROWLEY
USAID FOR AFR/SD, HOPE SUKIN AND AYANNA TOURE
ERIKA OLSON HHS/NIH/FIC

E.O. 12958: N/A
TAGS: TBIO OSCI KSCA KHIV MI
SUBJECT: POST RESPONSE - REQUEST FOR ASSESSMENT OF FOREIGN POLICY
IMPLICATIONS OF A PROPOSED RESEARCH PROJECT NO. AI050410 INVOLVING A
FOREIGN INSTITUTION

REF: STATE 146782


1. (U) Summary: Post thanks the Department for the opportunity to
weigh in on the proposed research project No. AI050410
"Acceptability of male circumcision as part of HIV prevention
strategies in Malawi" -Amy Corneli. Post concurs with the spirit of
the project and has no objection to it; however we would like to
record our reservations regarding implications of the proposal,
particularly regarding any premature inclusion of male circumcision
(MC) in a national HIV prevention program. End Summary.


2. (U) Post believes that this research project, conducted as
formative research, would cause no harm in Malawi and could help
further the study of male circumcision worldwide. Several countries
in the region have conducted formative research on the acceptability
of male circumcision. Also, researchers affiliated with the Ministry
of Health have conducted similar research in Malawi. The findings
were published in May 2006: "Acceptability of Male Circumcision for
Prevention of HIV Infection in Malawi"; Ngalande RC, Levy J, Kapondo
CPN, and Bailey RC; AIDS Behav.


3. (U) However, the stated objective of the research, "to generate
relevant data to inform future initiatives to implement male
circumcision as part of a comprehensive HIV strategy in Malawi"
raises some concerns. A premature recommendation for inclusion of
male circumcision as a strategy in Malawi's national prevention
program could result, in part, from this study.

This would be problematic due to the following:

- The Malawi DHS+ survey presents apparently contradicting results
to the prevailing protective value of male circumcision

- The role of confounders and effect modifiers attributing the
protective value of male circumcision have still not been fully
resolved (issues of culture, religion, ethnicity, occupation, condom
use, type of MC etc.)

- Other definitive prospective studies are underway in Kenya and
Uganda. Results from those studies may advise future use of MC in
any prevention strategy

- Existing proven HIV prevention interventions are barely being
operationalized and a focus on MC may detract from and even
undermine getting the other prevention efforts in place.

- Any future consideration of male circumcision should not only
await consensus position statements by reputable international
organizations such as WHO, UNAIDS, UNICEF, it should also be fully
endorsed by the Malawi Ministry of Health and the National AIDS
Commission.


4. (U) For any further questions regarding post's concerns over this
matter, you may contact Austin Demby, CDC Director,
ademby@mw.cdc.gov, +265-1-775-188.

EASTHAM