Circumcision could reduce the risk of AIDS

Jul 27 2005

In the first study ever, that has tried to use the procedure of circumcision specifically to prevent infection, researchers say it may help protect men from the AIDS virus.

United Nations health officials however are warning that more trials are necessary before they would be prepared to recommend this as a method to protect against AIDS.

The researchers speaking at the International AIDS Society Conference in Rio de Janeiro, said that circumcised men were 65 percent less likely to become infected with the deadly and incurable virus.

Other studies have also suggested that men who are circumcised have a lower rate of HIV infection, and apparently this has been especially noticeable in some parts of Africa, where some groups are routinely circumcised while neighboring groups are not.

It is believed by the researchers, that circumcision (removal of some or all of the prepuce foreskin) helps to cut infection risk because the foreskin is covered in cells that the virus seems able to easily infect.

It is also thought that the virus may also survive better in a warm, wet environment such as that found beneath a foreskin.

In their study, Bertran Auvert of the Institut national de la santé et de la recherche médicale (INSERM) and colleagues, tested more than 3,000 uninfected men aged 18-24 from South Africa's Guateng province, where 32 percent of adults are infected.

At the start of the trial some of the men were circumcised, while others had the procedure after 21 months.

At the conclusion of the trial, researchers recorded 69 HIV cases, but only 18 of them were in the men who were circumcised at the start.

Auvert, while admitting that although the protection rate was high it was only partial, says that the study shows that the intervention (circumcision), prevented between six and seven out of 10 possible infections.

He says the results were consistent with earlier simple observational studies in some African countries and India.

The United Nations AIDS Agency (UNAIDS) emphasizes that, although the trial shows the promising protective effects of adult male circumcision in reducing HIV acquisition, more research is needed.

UNAIDS hopes that two more studies underway in Uganda and Kenya will provide more evidence.

Catherine Hankins, UNAIDS chief scientific adviser, says the issue is a very sensitive issue one, and not just biologically.

She says it needs to be clear that circumcision should only be used as part of a package of preventive measures, such as the use of condoms, and behavioral changes to limit the number of sexual partners.

The World Health Organization is apparently working on guidelines for qualified medical personnel to carry out safe circumcision, as demand for the operation could well increase.

Health officials on the ground are however concerned that such demand may increase the number of operations carried out by healers and witch-doctors, which could boost the risk of HIV infection rather than prevent it, if they were not done correctly.

They also worry that a sense of false security from the operation is given, and the reduced sensitivity in the penis following circumcision could cause an increase in risky sexual behavior and a drop in condom use.