Important note: Information in this article was accurate in 1988. The state of the art may have changed since the publication date.
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Newsday - September 18, 1988
Laurie Garrett - Staff Correspondent
At the Third International Conference on AIDS and Related Cancers held here last week, Dr. Francis Plummer, of the University of Nairobi, presented striking evidence that transmission of the AIDS virus by women in Kenya correlates directly with lack of circumcision and with genital ulcers in their male partners.
It has been a theory for some time that the presence of openings through which the virus can reach the blood stream accounts for the transmission of the disease among heterosexuals in Africa. Both the absence of circumcision and genital ulcers are much more common in Africa than in the United States or Europe.
Plummer said the genital ulcerations and irritations found under the foreskin of uncircumcised men in Africa probably serve as entry points for the AIDS virus.
Plummer tested 1,000 Nairobi prostitutes, finding that 85 percent were infected with the AIDS virus. He then recruited 429 men who came into a Nairobi clinic for treatment of sexually transmitted diseases, all of whom said they got their infections from one of the city's prostitutes. All the men in his study claimed to have had a single sexual encounter that led to their infection.
Eleven percent of the men were already infected with the AIDS virus when the study began. Eight weeks later, Plummer retested the men: Another 8.2 percent were positive. Plummer found that among men in his study, those who were uncircumcised were eight times more likely to have become infected with the AIDS virus. Those who had a history of genital ulcer diseases, such as herpes, syphilis and chancroid, were also at greater risk for AIDS infection.
And nearly half the men who had both a history of genital ulcer disease and were uncircumcised became infected with the AIDS virus following a single sexual encounter with an infected prostitute.
"I think," said Plummer, "that we can now explain a lot of the African heterosexual AIDS dilemma. Ninety percent of the cases were due to either genital ulcer disease or lack of circumcision. And I think it fits well with the circumcision pattern in Africa in that where traditional circumcision is practiced, such as in West Africa, we see very little AIDS, but in East and Central Africa, where men are rarely circumcised, we have a serious AIDS problem."
Dr. James Chin, of the World Health Organization's Global AIDS program, said he was impressed by the Nairobi study, adding, "I don't think it's conclusive, but the heterosexual transmission issue is less of a question now. There is no doubt that genital ulcers predispose people to AIDS." Studies from Zambia and Zaire reported at this meeting found similar associations between circumcision, genital ulcers and AIDS.
Public education campaigns have had limited success in combating the AIDS virus.
Reports from several countries indicate Africans are largely unwilling to use condoms or dramatically change their lifestyles. For example, a survey of attitudes among high school students in nothern Tanzania found that 50 percent of the students would have sex with somebody they suspected was infected with the virus without using a condom.
Dr. Daniel Tarontola, of the World Health Organization, said African government support of condom campaigns has recently taken a dramatic turn. Twenty-eight out of 45 African contries now actively promote condom use.
"The AIDS situation in most of Africa has become so serious," Tarontola said, "that no prevention measure should be overlooked."
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