United Press International - Monday, 10 July 2000
Ed Susman, UPI Science News

"If you had a one-time intervention that could reduce the risk of becoming infected by more than 50 percent, wouldn't it be worth using that as an intervention?" asked Daniel Halperin, assistant professor of medical anthropology at the University of California, San Francisco, AIDS Research Institute.

In a symposium in which researchers presented a series of research papers on circumcision, Halperin noted that as many as 8 million cases of AIDS might have already been prevented in communities where African men have had circumcision for cultural or other reasons.

He said that circumcision is rare in the "AIDS Belt" of southern Africa, but the operation in which the foreskin is surgically removed from the penis is common in West Africa where AIDS rates are considerably lower.

"The evidence is strong enough, at least in my mind, to start trying to use circumcision as an intervention in AIDS," said Dr. Anne Buve of the Institute of Tropical Medicine, Antwerp, Belgium. "Male circumcision should be seriously considered as a preventive strategy," she said.

In her study, Buve reported that in two cities in West Africa, -- Yaound , Cameroon, and Cotonou, Benin -- the prevalence of human immunodeficiency virus (HIV) which cause AIDS among sexually active adult men was less than 4.5 percent. Almost all men in those cities are circumcised. Circumcision was less common in Kisumu, Kenya, and in Ndola, Tanzania, where only about 10 to 25 percent of men are circumcised, but where 20-25 percent have contracted HIV infection.

Dr. Eugene McCray, head of the Atlanta-based Centers for Disease Control and Prevention (CDC) global initiative to fight AIDS, said, "The question of using circumcision as an intervention against HIV infection is very community specific. You have to demonstrate that the operation will be accepted in the community before it can be attempted.

"However, numerous studies have shown that circumcision appears to have an impact on the rate of HIV infection. The CDC is willing to support pilot projects to look at circumcision as a way to combat AIDS," McCray said.

He said such studies might be difficult to establish but there were communities in Africa, particularly in Zimbabwe where cultural behaviors would make controlled studies possible and medically ethical. At the symposium, however, Ronald Gray, professor of population and family health sciences at Johns Hopkins School of Hygiene and Public Health, suggested that the differences seen between circumcised and uncircumcised men might have more to do with cultural and religious practices than a biological advantage to circumcision.

Almost all the circumcised men studied in a southwestern Uganda district by Gray and colleagues were Muslim. He suggested that Muslim prohibition against alcohol and risky sexual behavior might be the reason those men had lower risks of HIV infection.

McCray said researchers also need to study whether having a circumcision with its widely-believed lower risk for suffering infection might lead to riskier sexual behavior that could wipe out gains of having the procedure performed. Controlled studies, he said, could also tease out questions of whether earlier circumcision -- before puberty or first sexual experience -- can have an effect on protection against HIV infection.
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