A Question of the Cutting Edge: Male Circumcision & HIV

Male circumcision (removal of the foreskin of the male penis) is increasingly gaining currency as an alternative method to reduce HIV-infection. In sub-Saharan Africa, the worst affected region in the world, male circumcision (MC) could prevent six million new infections, researchers say.

In fact, evidence from observational studies in sub-Saharan Africa has shown that circumcised men have a lower risk of acquiring HIV infection than uncircumcised men. A study in South Africa showed that male circumcision might reduce by about 60% the risk of men contracting HIV through sexual intercourse with women. The study focused on 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Of these, half were randomly selected for circumcision while the other half remained uncircumcised and served as a control group.

For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. Researchers believed the findings were so significant they deemed it was unethical to proceed without offering the option to all males in the study.

The argument is that the inner surface of the foreskin contains Langerhans celles, which have HIV receptors, and is also vulnerable to traumatic epithelial disruptions during intercourse. Second, an intact foreskin exposes a man to a greater risk of ulcerative sexually transmitted infections, which in themselves are a risk factor for HIV acquisition. Furthermore, the virus’ chances of survival might be higher in a warm, wet environment like the one under the foreskin.

The evidence that circumcision may protect against HIV infection is now considered strong enough that trials evaluating the efficacy of transmission as part of an HIV prevention program have been advocated. This could herald a new era in HIV-prevention methods.

According to USAID, qualitative studies in Botswana, Haiti, Tanzania, Zambia, and Zimbabwe have revealed favorable attitudes toward MC in populations that do not traditionally practice circumcision. From 45 to 85 percent of uncircumcised men in surveys have expressed interest in the procedure if it is safe and affordable.

In spite of the interest in male circumcision, it is not a magic bullet in the fight against HIV/AIDS. To be effective, circumcision has to be promoted alongside condom use and faithfulness, traditional approaches in the fight against HIV and AIDS.

Some men may be tempted to engage in unprotected sex because they perceive they are protected by male circumcision. In itself, male circumcision provides little or no protection against urethral STDs such as gonorrhea and chlamydia and certainly cannot prevent unwanted pregnancies.

To be successful, male circumcision will have to be complemented by a massive investment into education and counseling programs. There will be need for widespread and culturally sensitive dissemination of information that outlines the benefits and potential complications of male circumcision.

Another danger is that male circumcision can be risky or fatal if conducted by untrained personnel. Most health facilities in sub-Saharan Africa are in a shambles, putting great doubt on the efficacy of male circumcision.

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3 thoughts on “A Question of the Cutting Edge: Male Circumcision & HIV

  1. In at least seven African countries, more of the circumcised men have HIV than the non-circumcised. The three African trials are not nearly as impressive as the media versions make out. Less than two years after circumcising 5,400 men and leaving a similar number intact, 64 of the circumcised men had HIV compared to 137 of the non-circumcised (while 673 men dropped out, 327 of them circumcised, their HIV status unknown). That is the whole basis of the claim that “millions could be protected”.

    “To be effective, circumcision has to be promoted alongside condom use and faithfulness, traditional approaches in the fight against HIV and AIDS.”

    A traveller came to a farmhouse and offered to make the occupants Nail Soup in return for a night’s shelter. He threw a large nail in a pot of boiling water and said –
    β€œTo be effective, a nail has to be used alongside herbs, spices, vegetables and meat, traditional approaches in the making of good soup.”

    In the morning he went on his way, refreshed after a night in a comfortable bed, minus the nail, with some gold coins in his pocket and the thanks of the family ringing in his ears for the wonderful nail that made such delicious Nail Soup.

    So it will be when mass circumcision has been “rolled out” and if there is any dent at all in HIV transmission.

  2. “To be successful, male circumcision will have to be complemented by a massive investment into education and counseling programs.”

    Will this education tell of the functions of the foreskin (Taylor’s Frenulum Delta and its loss to circumcision), and that the most sensitive parts are cut off (Sorrell’s et al. Fine-touch pressure thresholds in the adult penis) ?
    The CDC has failed at education. It has not educated its US males about circumcision let alone the penis. Their own report shows 30% and 35% of teenage boys are mistaken about their own circumcision status. Further the CDC has taken up considering promoting circumcision along with the AAP Project base on the African studies which chose to not consider important confounders. (Doctors Opposing Circumcision and CircumcisionAndHIV) Education is needed in the CDC itself for inviting Operation Abraham to its sponsored conference where science turned into a picture on the conference overhead screen showing an intact penis with a body of an elephant drawn about it as its trunk. With the words “Yes! A circumcision please.” ‘”Operation Abraham” is an Israel-based group that apparently hopes to be engaged to assist the U.S. in circumcising black and Hispanic males.’ ‘And apparently they think it is socially and ethically acceptable to denigrate a normal body part and to attempt to humiliate all intact boys and men into submitting to circumcision.’ (http://tinyurl.com/qnmt8b)

    The US has the highest rate of male circumcision, the highest rate of STDs, and the highest rate of HIV of the developed world. Nothing can compare to this! Enough said.

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