AIDS and circumcision - the jury's still out

Mar 8 2007

According to preliminary results of a study in Africa, although circumcision offers men some protection from the AIDS virus, if they are already-infected, unless they let the penis heal completely they may put women at an even higher risk of contracting the virus.

The early findings by researchers working in Uganda with 997 HIV-infected men, indicate that women who had sex with a man who did not wait to heal fully after circumcision, seem to have a higher risk of infection than through sex with an uncircumcised infected man.

The researchers tracked infection rates of 113 previously uninfected female partners of infected men and found of 12 women who had sex with infected men before the circumcision wound was fully healed, three became infected within six months.

While of the 55 female partners of infected circumcised men who waited to resume sex until the wound healed, six became infected, which was similar to the infection rate of female partners of uncircumcised infected men - four of 46.

Whereas when infected men had waited until a doctor certified that the wound had completely healed before having intercourse, there appeared to be no increased risk for female sex partners.

Both the men and women were given repeated HIV prevention education and free condoms.

The researchers suspect that intercourse might cause tiny tears in the surgical wound, which then allows HIV-infected blood to enter the woman's vagina.

Dr. Maria Wawer of Johns Hopkins University in Baltimore, the study leader, says they do not in any way mean to discredit the incredible value of male circumcision for the prevention of HIV acquisition in men.

The researchers say as the wounds from circumcision take roughly four weeks to heal it is important for men to abstain from sex until fully healed.

The majority of HIV-infected people in Africa are women who have as a rule contracted HIV by means of heterosexual sex.

Social and economic inequalities between men and women are thought to be responsible for the elevated rates of infection in women because many women are trapped in relationships with unfaithful men.

Although the study will not be completed for another two years, the preliminary findings were announced in Switzerland and coincide with circumcision policy recommendations being considered by U.N. health officials.

Health experts believe that circumcision may be an effective method of reducing HIV infection in Africa, as earlier studies have shown that circumcised men are 50 to 60 percent less likely to become infected with the human immunodeficiency virus; but the resulting effect on women is unclear.

This is because it is the cells on the inside of the foreskin, the part of the penis cut off in circumcision, are particularly susceptible to HIV infection.

HIV may also possibly survive better in the warm, damp environment beneath foreskin.

Africa is the continent hardest hit by AIDS and of the 39.5 million people worldwide infected with HIV, 24.7 million are in sub-Saharan Africa.

Dr. Kevin De Cock, director of the World Health Organization's Department of HIV/AIDS, has said the data presents a paradox but is preliminary, incomplete and statistically insignificant because of the few people involved.

He says circumcision is an additional prevention strategy rather than a replacement for anything else.

He suggests when the study is completed, it might show circumcision can protect a man's female sex partner.

The team at Johns Hopkins, the Rakai Health Sciences Program and Makerere University in Uganda also believe circumcision to be important in AIDS prevention efforts.

Experts say women are already very vulnerable as regards the HIV epidemic, and particular care needs to be taken so they are not put at an even greater risk.

The study they say illustrates the importance of finding ways to protect women in the search for ways to fight AIDS.

It is estimated that as many as 25 million people have died from AIDS since it was first identified a 25 years ago.