Thursday, December 14, 2006

Male circumcision and HIV :: BBC

Circumcision can cut the rate of HIV infection in heterosexual men by 50%, results from two African trials show.
. . .
The two trials of around 8,000 men took place in Uganda and Kenya were due to finish in July and September 2007 respectively.

But after an interim review of the data by the NIH Data and Safety Monitoring Board decided to halt the trials as it was unethical not to offer circumcision in the men who were acting as controls.
. . .
A further trial in Uganda to assess the risk of HIV transmission to female partners is due to report in 2008 but the effect among men who have sex with men has not yet been studied.
. . .
Tom Elkins, Senior Policy Officer at the National AIDS Trust warned: "There is a real danger in sending out a message that circumcision can protect against HIV. This is not the case and could lead to an increase in unprotected sex.

"There is still a long way to go in providing comprehensive prevention programmes in many countries, and resources should go into normalising the use of condoms, which are the most effective method currently available for preventing HIV."

Indeed. How will behavior change once it is know that circumcision reduces the risk of spread of HIV in men? Will women be under more pressure to have unprotected sex? Will HIV transmission risk increase?

The NYT has more:
Researchers have long noted that parts of Africa where circumcision is common — particularly the Muslim countries of West Africa — have much lower AIDS rates, while those in southern Africa, where circumcision is rare, have the highest.

But drawing conclusions was always confounded by other regional factors, like strict Shariah law in some Muslim areas, rape and genocide in East Africa, polygamy, rites that require widows to have sex with a relative, patronage of prostitutes by miners, and men’s insistence on dangerous “dry sex” — with the woman’s vaginal walls robbed of secretions with desiccating herbs.

Outside Muslim regions, circumcision is spotty. In South Africa, for example, the Xhosa people circumcise teenage boys, while Zulus do not. AIDS is common in both tribes.

Nelson Mandela’s autobiography, “Long Walk to Freedom,” contains an unnerving but hilarious account of his own Xhosa circumcision, by spear blade, as a teenager. Although he was supposed to shout, “I am a man!” he grimaced in pain, he wrote.

But not all initiation ceremonies are laughing matters. Every year, some South African teenagers die from infections, and the use of one blade on many young men may help spread AIDS.
. . .
Male circumcision also benefits women. For example, a study of the medical records of 300 Ugandan couples last year estimated that circumcised men infected with H.I.V. were about 30 percent less likely to transmit it to their female partners.
Related: Here's news of a new "smart molecular condom" for women.



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