AIDS: New evidence backs circumcision campaign

by Richard Ingham

A campaign to encourage African men to get circumcised to prevent infection by HIV gained a powerful boost Wednesday by three new studies unveiled at the world AIDS forum in Rome.

New cases of HIV among fell by an astonishing 76 percent after a circumcision programme was launched in a South African township, researchers reported.

Had no circumcisions been carried out, the tally of new infections among the overall population, men and women combined, would have been 58 percent higher.

"This study is a fantastic result for a simple intervention which costs 40 euros (56 dollars), takes 20 minutes and has to be done only once in a lifetime," said David Lewis, of the Society for in Johannesburg and the University of the Witwatersrand, South Africa.

In 2006, trials in Kenya, Uganda and South Africa found foreskin removal more than halved men's risk of infection by the (HIV).

Longer-term analysis found the benefit to be even greater than thought, with a risk reduction of around 60 percent.

After pondering risks and benefits, health watchdogs set in motion circumcision campaigns in 13 sub-Saharan countries that have been badly hit by the .

Advocates call it "surgical vaccine", describing it as a cheap yet effective form of prevention.

Sub-Saharan Africa is home to two-thirds of the 33 million people living with HIV. As of mid-2010, around 175,000 circumcisions had been carried out in the 13 countries considered priorities, according to UNAIDS.

The new study was conducted between 2007 and 2010 in Orange Farm, a township of 110,000 adults, where more than 20,000 circumcisons had been performed, especially in the 15-24 age group which is most sexually active.

Two other studies released in Rome added to the good news about circumcision:

-- say they experience greater after surgery, a finding that should help overcome unease about the operation.

Investigators at the University of Makerere interviewed 316 men, average age 22, who had been circumcised between February and September 2009.

A year after the operation, 220 of the volunteers said they were sexually active, of whom a quarter said they used condoms.

A total of 87.7 percent said they found it easier to reach an orgasm after being circumcised, and 92.3 percent said they experienced more sexual pleasure.

-- Newly-circumcised men are just as likely as uncircumcised men to practice safe sex, according to interviews conducted among 2,207 men in western Kenya, six months after they had had the operation.

This helps ease concerns that circumcised men are tempted to abandon condom use in the belief they are completely shielded from HIV.

France's 2008 Nobel laureate Francoise Barre-Sinoussi, who in 1983 co-identified HIV as the source of AIDS, said over-confidence in circumcision was a major anxiety.

"Nothing provides 100-percent protection, not even a vaccine," she told AFP. "Let's stop thinking that one preventative tool is enough. Circumcision has to be part of a combined approach."

The theory behind the benefits of circumcision is that the inner foreskin is an easy entry point for HIV. It is rich in so-called Langerhans cells, tissue that the AIDS virus easily latches on to and penetrates.

On the downside, male circumcision does not reduce the risk for women who have intercourse with an HIV-infected man, and the protective benefit does not seem to apply to homosexual intercourse.

There is an indirect advantage, though. The fewer men who are infected with HIV, the smaller the risk of infection for others.

"Science is proving that we are at the tipping point of the epidemic," said Michel Sidibe, executive director of UNAIDS.

Scaling up voluntary to young men in places with HIV prevalence will help reach the UN's 2015 goal of halving sexual transmission of the disease, he said.

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Sigismond
5 / 5 (2) Jul 21, 2011
Breast ablation too is a weapon against breast cancer.
Sigismond
5 / 5 (1) Jul 21, 2011
"87.7 percent said they found it easier to reach an orgasm after being circumcised, and 92.3 percent said they experienced more sexual pleasure." A BIG LIE!!!

THIRD BIG LIE: "On the downside, male circumcision does not reduce the risk for women who have intercourse with an HIV-infected man" - Sure, THEY DO NOT TELL that it does strengthen the risk by 55%!!! (Wawer's enquiry)
freethinking
3 / 5 (2) Jul 21, 2011
Something is fishy here. Slight reduction in risk is a possiblity (though I doubt it).
Sigismond
not rated yet Jul 22, 2011
Preaching both abstinence and the removal of the specific organ for manusexuality is utterly illogical.
Sigismond
5 / 5 (1) Jul 22, 2011
The 55% higher risk for women can be calculated from Dr Wawer enquiry: Wawer M., Makumbi F., Kigozi G., Serwadda D., Watya S., Nalugoda F. and others. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009 (374-9685) : 229-237.

Indeed, the enquiry gives figures of declared infections by the HIV of:

17/92 = 18.48%, for the circumciseds' companions,

and 8/67 = 11.94% for the intacts' companions,

now 18.48 - 11.94 = 6.54, and 6.54/11.94 = 54.77% higher risk.
freethinking
1 / 5 (1) Jul 22, 2011
Sigismond, I'm with you and I'm against circumcising in general. I do however support the parents choice for infants, as there are pro's and conns to circumcision. I myself think the cons outweigh the pros. I don't mind factual information about circumsion, that said, when AIDS gets involved, politics and special interests get involved.

I think there is something wrong with this study, not sure if it is because of poor science, politics, or special interests.

First Big alert was when they said 92.3% experienced more sexual pleasure. Given that there is a large % of men who say the oposite, I think this is very likely the same thing as when a communist dictator wins an election by that margin.

2'nd big alert, such a high protection factor. 76%

I say follow the money. Who is getting the money and for what?
ml66uk
not rated yet Jul 23, 2011
From the USAID report "LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS"
"There appears no clear pattern of association between male circumcision and HIV prevalencein 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
http://www.measur...CR22.pdf

The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".
http://www.info.g...2009.htm

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.
http://www.thelan...abstract
Hugh7
not rated yet Jul 24, 2011
76% sounds like a lot, but we need to know more about the actual figures. This was just a presentation at a conference, not a published peer-reviewed scientific paper yet.

The same researchers found in the same place in 2001 that customary circumcision showed no protective effect, sugggesting that it is something else that makes the difference.

The circumcised men were younger, more educated, and more aware of their HIV status than those who were not circumcised. That in itself may hold the answer for the lower HIV rate, and nothing to do with circumcision. Being younger, they have had less opportunity to be infected. Being more educated, they may be more careful (as also shown by their greater awareness of their status). They all volunteered for circumcision, so they might be more careful anyway.

We should be very careful about claims that circumcision itself is protective. It has a sorry history of being a "cure" in search of a disease, an act in search of an excuse.
Hugh7
not rated yet Jul 24, 2011
The study claiming to show that circumcised men enjoy sex more could not be double blinded; both interviewers and subjects knew what the "right" answers were.

All the subjects were volunteers for circumcision; men who valued their foreskins would have stayed away.

Therefore, as objective science, this study (not yet published in a peer-reviewed journal) is not worth a hill of beans.