PARIS, Feb 23, 2007 (AFP) - Trials showing that male circumcision more than halves the risk of HIV infection are published in The Lancet on Friday, giving the seal of approval to calls for circumcision to be cautiously launched as an AIDS prevention strategy.
The trials, conducted in Kenya and Uganda and earlier in South Africa, found that men who were uncircumcised were twice as likely to catch the human immunodeficiency virus (HIV) compared with circumcised counterparts.
The data were so dramatic that the trials in Kenya and Uganda were halted ahead of schedule, for it would have been ethically wrong to continue them.
The trials' results were announced by their researchers last year.
But Friday's publication in the peer-assessed Lancet of the Kenya and Uganda research is the medical community's de-facto validation of the findings, and enshrines circumcision's place in the war against AIDS.
"We have proof of a permanent intervention that can reduce the risk of HIV infection in men, which is positive news about prevention after past and current disappointments," said a commentary by Marie-Louise Newell and Till Barnighausen of the University of KwaZulu-Natal in South Africa and the Harvard School of Public Health.
They calculate that in KwaZulu-Natal province, where HIV incidence is very high but circumcision rates very low, 35,000 new infections could have been prevented in 2007 alone if the 2.5 million men there had been circumcised.
In addition to being preventive, circumcision also carries cost benefits. The operation is cheap, whereas treatment for HIV infection entails a lifelong dependence on expensive drugs.
But Newell and Barnighausen join other experts in saying that the urge to swiftly implement circumcision should be leavened with caution.
Governments and doctors have to tread carefully in advising circumcision, they said. In some cultures, circumcision is considered a rite of passage to adulthood and a symbol of manhood; in others, it is considered an emasculation.
In addition, the operation has to be conducted in sterile conditions by trained personnel, and this will require resources for awareness campaigns and set up medical facilities.
Most importantly, reduction of risk is not the same as elimination of risk, which means that circumcised men should still be encouraged to wear a condom.
"The emerging truth is that no single approach alone will be able to stem the spread of HIV," The Lancet said in an editorial.
Botched operations and the temptations of unsafe sex could squander a historic opportunity, it said.
In Geneva, the World Health Organization (WHO) and UNAIDS welcomed publication of the trials in Kenya and Uganda.
"Male circumcision has major potential for the prevention of HIV infection," said Kevin De Cock, director of the WHO's HIV/AIDS department.
WHO and UNAIDS have convened an international meeting in early March to examine the results of the new trials and assess their impact on AIDS policies.
The theory behind circumcision's protective effect is that the foreskin has a very thin epithelium, or lining, and easily suffers minor abrasions during intercourse.
These microscopic cuts make it easier for the AIDS virus to enter the man's bloodstream.
Another mooted reason is that the foreskin is rich in so-called Langerhans cells whose surface configuration makes it easy for the AIDS virus to latch on to them.
070223
AF070284
Copyright ©AFP 2007. All Rights Reserved. AFP articles contained on the AEGiS web site may not be reproduced, distributed, transmitted, displayed, published or broadcast without AFP's prior written permission. You may make one copy of each article for your personal, non-commercial use only; more copies would require AFP's prior written permission obtained from the owners of any trademarks or copyrighted materials whose marks and materials are included in AFP photos or materials. Therefore you will be solely responsible for obtaining any and all necessary releases from whatever individuals and/or entities necessary for any uses of AFP stories, photos or graphics. http://www.afp.com/
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, John M. Lloyd Foundation, the National Library of Medicine, Roche and Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2007. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.