Routine Male Circumcision Could Reduce A Man's HIV Infection Risk By About 50 Percent, According To Studies Conducted In Kenya, Uganda, 19 Dec 2006 12:21:07 GMT Source: Reuters
Routine male circumcision could reduce a
man's HIV infection risk through heterosexual sex by about
50%, according to data from two studies conducted in Kenya and
Uganda released Wednesday by NIH, the New York Times reports (McNeil,
New York Times, 12/14). Researchers monitored
4,996 men ages 15 to 49 living in Uganda and 2,784 men ages 18
to 24 living in Kenya -- half of whom were randomly assigned
to be circumcised and the other half served as a control group
-- to determine if circumcision reduced HIV infection, the Los Angeles Times reports.
According to the Times, all participants in both
studies received counseling on HIV risk reduction and were
advised to use condoms (Maugh, Los Angeles Times,
12/14). According to researchers, male circumcision eliminates
the cells most vulnerable to HIV. In addition, a circumcised
penis develops thicker skin that is resistant to HIV
infection, the Washington Post reports. Many
African tribes used to perform ritual male circumcisions when
adolescent boys became men, but the practice in recent years
has declined, according to the Post. African
countries with low male circumcision rates -- including
Botswana, South Africa, Swaziland and Zimbabwe -- have the
highest HIV prevalence, compared with West Africa, where male
circumcision is a common practice and HIV prevalence is lower,
the Post reports. The Uganda study found 43 cases
of HIV among the uncircumcised men, compared with 22 among the
circumcised men -- a 48% reduction of HIV transmission. The
Kenya study found 47 cases of HIV among uncircumcised men,
compared with 22 among the circumcised men -- a 53% reduction.
According to the Post, the results of the studies
were so overwhelming that NIH stopped the trials early and
offered circumcision to all participants (Timberg,
Washington Post, 12/14). The researchers also
found no evidence that the circumcised men in the studies
adopted higher-risk sexual behaviors, including sex with
multiple partners and unprotected sex (Smith, Boston Globe, 12/13).
South Africa Study The results of the Uganda and
Kenya studies "echoed" similar results of a study conducted in
South Africa in 2005, according to the Post
(Washington Post, 12/14). The South Africa study
was based on an analysis of findings from a previous study in
the country that indicated that male circumcision
significantly reduces HIV infection. According to the South
Africa study, which was published in the November 2005 issue
of PLoS Medicine, male circumcision
might reduce by about 60% the risk of men contracting HIV
through sexual intercourse with women. The randomized,
controlled clinical trial enrolled more than 3,000
HIV-negative, uncircumcised men ages 18 to 24 living in a
South African township. Half of the men were randomly assigned
to be circumcised and the other half served as a control
group, remaining uncircumcised. For every 10 uncircumcised men
who contracted HIV, about three circumcised men contracted the
virus. Researchers believed the findings were so significant
they deemed it was unethical to proceed without offering the
option to all males in the study (Kaiser Daily HIV/AIDS Report,
7/12).
Implications, Reaction, Next Steps The results
of the Uganda and Kenya studies "appear to have tipped the
balance," and UNAIDS and the World Health
Organization on Tuesday announced that they will rapidly
convene a panel of experts to ascertain how the findings can
be implemented, according to the Los Angeles
Times (Los Angeles Times, 12/14).
Ambassador Mark Dybul, who serves as the U.S. global AIDS
coordinator and administers the President's
Emergency Plan for AIDS Relief, in a statement said PEPFAR
"will support implementation of safe medical male circumcision
for HIV/AIDS prevention" if world health agencies recommend
it, the Times reports. In addition, Richard
Feachem, executive director of the Global Fund
To Fight AIDS, Tuberculosis and Malaria, said that if a
country submitted plans to conduct sterile circumcisions, "I
think it's very likely that our technical panel would approve
it." The study results are "very exciting news," Daniel
Halperin, an HIV specialist at the Harvard Center for Population and Development
Studies, said, adding, "I have no doubt that as word of
[the study] gets around, millions of African men will want to
get circumcised, and that will save many lives." Kevin De
Cock, director of the WHO's HIV/AIDS
Department, said that male circumcision is "not a magic
bullet, but a potentially important intervention." Sex
education messages for young men must clarify that "this does
not mean that you have an absolute protection," Anthony Fauci,
director of NIH's National Institute of Allergy and Infectious
Diseases, said. According to Fauci, male circumcision
should be used along with other HIV-prevention methods, and
the procedure does not reduce the spread of HIV through anal
intercourse or injection drug use, two ways in which HIV is
commonly spread in the U.S. (New York Times,
12/14). The Bill and Melinda Gates Foundation is funding a
fourth study in Uganda on the link between male circumcision
and HIV transmission that will examine whether women also
benefit from male circumcision in terms of reduced risk of
contracting HIV, the San Francisco Chronicle
reports (Russell, San Francisco Chronicle,
12/14). A study conducted recently in Uganda estimated that
circumcised men were 30% less likely to transmit HIV to their
female partners (New York Times, 12/14).
Related Editorial The results of the male
circumcision studies might be "the most important development
in AIDS research since the debut of antiretroviral drugs," and
groups such as UNAIDS and WHO should "move as quickly as
possible" to determine how best to promote the procedure in
developing countries, a New York Times editorial says.
Donors also should "work urgently to provide new financing to
help high-risk countries train community workers to do safe
circumcision," the editorial adds. According to the editorial,
HIV prevention efforts until now have "largely failed" because
they "requir[e] people to resolve every day either not to have
sex or to use condoms"; however, circumcision is a "one-time
procedure" that is "familiar and widely accepted" worldwide.
The editorial notes that any campaign to promote circumcision
must be "coupled with warnings" that the procedure offers
"only partial protection against HIV and should not become a
license for risky sex." For years, the "holy grail of AIDS
prevention has been a vaccine," but with the release of the
study, "we know [a vaccine's] near equivalent exists," the
editorial says, concluding, "International donors and
governments should join together to spread the good news about
circumcision and make the procedure available everywhere"
(New York Times, 12/14).
