Bringing science and development together through news and analysis

  • Circumcised men less likely to get HIV, says study

[RIO DE JANEIRO] Men who are circumcised are less likely to contract HIV/AIDS from their female partners, according to research presented this week (26 July) at the 2005 International AIDS Society (IAS) conference in Rio de Janeiro, Brazil.

The research was done in South Africa by Bertrand Auvert, of the French National Institute of Health and Medical Research (INSERM), and Dirk Taljaard, of the Progressus Research and Development Consultancy in Johannesburg, South Africa.

In 2002, the scientists recruited more than 3,000 uncircumcised heterosexual men aged 18 to 24 from Orange Farm, a Johannesburg suburb where about 32 per cent of women have HIV.

Half these men were then circumcised.

Three years later, 51 of the uncircumcised men were diagnosed with HIV, compared with just 18 of those who had been circumcised.

"It means we prevented six or seven out of a possible ten infections," says Auvert.

Because of the marked difference between the two groups, and following the advice of the Data Safety and Monitoring Board, the trial was stopped and all participants were offered circumcision.

Two similar trials are currently underway in Kenya and in Uganda. Together, they involve another 8,000 men.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) says the results of these trials are important to clarify the relationship between circumcision and HIV.

It adds that the results of the South African trial "must be considered in the context of the cultural acceptability of promoting circumcision, the risk of complications from the procedure, the additional risk associated with circumcisions performed under unhygienic conditions, and the potential to undermine existing protective behaviours and prevention strategies that reduce the risk of HIV infection."

In a joint statement, three UN bodies, including UNAIDS, and the World Health Organization (WHO) warned that even if male circumcision is confirmed to reduce the risk of acquiring HIV, this will not mean that circumcised men are risk-free.

Charles Gilks, of the WHO's HIV/AIDS department, says he is concerned that men might rush to get circumcised in unsafe procedures and subsequently abandon other precautions in sexual intercourse, such as using condoms.

According to Auvert, an uncircumcised penis is more likely to be infected because the moist environment underneath the foreskin helps the virus — and other organisms that cause sexually transmitted diseases — survive and reproduce.

Also at the IAS conference, Rebecca Stallings, of the US Macro International Research Corporation Company, presented a study of female circumcision.

The trial involved 7,154 HIV positive women in Tanzania. According to Stallings, female circumcision appears to increase the risk of women being infected with HIV.

She says this is because the surgery itself increases the vulnerability of the genital skin.

In addition, says Stallings, circumcised women are more likely to have anal intercourse, which also increases the chances of infection.

The Lancet medical journal last year published the results of a study in India that suggested there was a link between circumcision and lower HIV infection rates (see AIDS risk 'cut by circumcision').

Unlike the South African trial however, the Indian study did not randomly circumcise half the participants. Rather, the researchers observed whether already circumcised men were more or less likely to become infected with HIV.

The Lancet decided against publishing the South African study. According to a report in The Wall Street Journal online, this was "for reasons unrelated to the data and scientific content". The Lancet, following its standard policy, declined to tell SciDev.Net why it chose not to publish the study. 

Link to full paper in PLoS Medicine