Adult Male Circumcision Reduces HIV Acquisition Risk

Ruzanna Harutyunyan's picture
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Medical circumcision of adult men continues to reduce the risk of acquiring HIV through heterosexual intercourse for at least 3.5 years. This finding recently emerged from an analysis of long-term follow-up data on Kenyan men who have participated in a large clinical trial assessing the protective value of adult male circumcision against HIV infection.

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Among the 2,784 Kenyan men who have participated in the study, some for as long as 3.5 years, 62, or 7.45 percent, have acquired HIV while uncircumcised and only 27, or 2.6 percent, have acquired HIV after circumcision. Nearly 1,830 of the study participants are now circumcised. It is estimated from the study data that circumcision reduces a man’s risk of acquiring HIV by 64 percent. The investigators will present these data on August 7 at the XVII International AIDS Conference in Mexico City.

The Kenyan study is a follow-up component of one of two clinical trials sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), that were stopped in December 2006—before their scheduled completion—because of the overwhelming evidence that medically supervised circumcision can reduce a man’s risk of acquiring HIV through heterosexual intercourse. The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction in HIV acquisition among circumcised men compared to uncircumcised men, while a study of 4,996 HIV-negative men in Rakai, Uganda, demonstrated a 48 percent reduction in HIV acquisition among circumcised men. NIAID is co-sponsoring the follow-up Kenyan study in connection with the Canadian Institutes of Health Research.

In response to the results of these studies and an earlier randomized trial conducted in Orange Farm, South Africa, the World Health Organization recommended in 2007 that male circumcision be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men.

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Comments

How could they carry on the study after they had offered the control group circumcision? Those who accepted would not be a random sample of the original population. More cautious, perhaps, and hence at less risk? (All the men had volunteered to be circumcised sooner or later, meaning they were not a random sample of the general population either. This is only one of many reasons to be skeptical of the original studies.10% of the men have been lost from study, their HIV status unknown - several times as many as are known to have been infected.) The ever-reducing population involved increases the inaccuracy. And isn't it getting a bit obvious that the same few researchers (Auvert, Bailey, Gray, Halperin) who are pushing circumcision as hard as they can, are the same ones who carried out all the studies claiming to show it is beneficial in every possible way? And what a coincidence that just when circumcision was falling out of favour, after more than a century of chasing whatever disease was most feared at the time (even masturbation was seriously believed to cause serious illness in the late 19th century), it's "found" to be good against AIDS? Something about circumcision (maybe just the fact that it's very common, including among the people promoting it) makes people lose their critical faculties.
In the absence of an effective vaccine, viable AIDS-prevention policies must accommodate underclass, outlaw, and foreign-culture realities in order to be viable. Both microbicides and male circumcision presume that the men and women most at risk for getting and spreading HIV infections have the intellect, understanding, foresight, desire, willpower, and discipline it takes to undertake such protective measures AHEAD of time. Instead of steps that raise suspicions and threaten their prospects of sexual success BEFOREHAND, members of these at-risk populations need something easy that can be done in private AFTER they have engaged in possibly risky sex. Since 1993, Nigel O'Farrell, M.D., a British researcher affiliated with the London School of Hygiene and Tropical Diseases, has published a series of studies done in South Africa that demonstrate and explain why post-sex penile washing can prevent HIV infections. Since 1996, dozens of leading private healthcare providers in the U.S.A. have included this recommendation -- for women as well as men -- in their books and web sites. The U.S. National Institutes of Health and its funded programs must remain mute because NIH has just begun to fund hygiene-focused prevention research. But "MedlinePlus.org," the health information directory published by the U.S. National Library of Medicine, offers a page of links about STD and AIDS prevention that includes several authoritative sources of this recommendation. One is its own introductory tutorial on STDS. Another is the STD-prevention discussion on the site of the American Association of Family Physicians. The most significant piece of U.S.-funded scientific research to demonstrate the effectiveness of post-sex washing as a technique for reducing HIV infections is a study undertaken with the help of Professor King K. Holmes, M.D., Ph.D., widely considerd the dean of STD studies in the U.S.A., published in the respected "Journal of AIDS" in 2006. Holmes et al. determined that post-sex penile washing could reduce the risk of HIV infections by studying a sample of poor men drawn heavily from the Kibera slum area of Nairobi, which is heavily populated by members of the Luo tribe. Luo elders have long taught their young men both to remain uncircumsized and to wash their penises after sexual intercourse. Bailey et al conducted their study of male cirumcision in Kisumu, Kenya, long a Luo capital. Were they informed enough about Luo customs to ask if the subjects they circumsized continued to wash their penises after sex? Did they undertake the sophisticated statistical research necessary to ascertain that it was the circumcision rather than the habitual penile washing that resulted in reduced rates of HIV infection?