Circumcision, HPV, or STD

A recent study shows that circumcision cuts in half the rate of HIV infection in Uganda and similar results are expected in a study in South Africa. The cost of a circumcision in South Africa is about $55 per procedure. Jim Kahn of the University of San Francisco estimates that it takes about 10 ($550) procedures to prevent one infection. This article also goes on to say that 99% of men reported their partners were “very satisfied” with their circumcision and that 80% of men in Africa would get circumcised if it prevented HIV. The total predicted decrease in HIV infections would be on the order of 1.4 million people in Sub Saharan Africa, if circumcision reduced HIV infection by 50%.

Another breakthrough in preventing the ill effects of sexually transmitted diseases is the HPV vaccine that was recently approved by the FDA. The vaccine currently costs about $300. I have not found similar numbers for projected HPV prevention, but I will try to create my own here. 270,000 women each year die of cervical cancer, most deaths take place in developing countries. Lets assume 90% take place in the developing world, which I believe I saw quoted, so that’s 243,00 death in the developing world. But the vaccine only prevents 70% of cancers. That’s 170,000 a year in the whole developing world. From an economics stand point the HPV vaccine reduces the total deaths in the whole developing world is about one-tenth of the number of HIV infections prevented by circumcision in Sub Saharan Africa alone. In addition the procedure is almost 6 times as expensive. Now I’m comparing cancer deaths with HIV infections, but still the numbers suggest circumcision is more effective.

While these two stories may be getting the press, perhaps we should return to the recent work of Emily Oster. She found (here) that treating sexually transmitted diseases leads to decreased transmission of HIV in Africa. Her work suggests that to prevent one HIV infection through treatment of STDs it would cost about $78 or about 1/8 the cost of the 10 circumcisions needed to prevent an HIV infection.

So in conclusion. First we send the anti-biotics, then we send the mohels, then we start to worry about HPV.