Circumcision May Offer Powerful 70% HIV Prevention

Circumcision May Offer Powerful 70% HIV Prevention

Tue, 5 Jul 2005

A front page report in the Wall Street Journal reveals that a controlled clinical study conducted by French and South African researchers have found that circumciion reduces the risk of transmitting AIDS by 70%.

“The circumcision findings were so dramatic that the data and safety monitoring board overseeing the research halted the study in February, about nine months before it would have been completed, on the grounds that it would be immoral to proceed without offering the uncircumcised control group the opportunity to undergo the procedure. While men were directly protected from infection by circumcision, women could benefit indirectly because circumcision would reduce the chances their partners would be HIV-positive.”

The Journal correctly points out, “The fact that an independent board ordered the study halted is considered a strong sign that the science is sound.

This raises serious questions about why the investigators of such a major breakthrough finding n AIDS research have not yet found a journal that would publish their report? Indeed, The Lancet refused to publish, arrogantly refusing to provide an explanation!

One cannot ignore the fact that this finding threatens the AIDS industry which is entirely focused on drugs and vaccines‹

The Journal notes: “Vaccine developers have said they would consider an AIDS vaccine with just 30% efficacy useful.”

From the list of citations that follow the articles below, it would appear that the South African study findings are corroborated by a body of evidence linking circumcision to HIV infection prevention (as well as other sexually transmitted cancerous infections).

From a woman’s perspective, influential Anglo-Saxon scientists and journal editors appear to have a preconceived prejudice against circumcision that undermines their ability to dispassionately evaluate and report vital life-saving scientific findings.

See also: Journal Of Infectious Deseases, Jan 20, 2005 “Male Circumcision Reduces Risk Of HIV Transmission From “Women To Man”

Tue 6 April, 2004 Epidemiology. Reuters Health “Circumcision Found to Reduce HIV Risk, Again

USA Today, April 12, 2002 Women Have Less Cervical Cancer Risk If Their Sex Partners Are Circumcised

The BBC News, April 10, 2002 Circumcision Curbs Cervical Cancer Risk

The Canadian Press, April 10, 2002 Circumcised Men Less Likely To Spread Cancer Causing Virus

Ivanhoe Newswire, Nov,2004 Study shows male circumcision may help prevent AIDS transmission

Journal Of Clinical Pathology, January, 2004: 57:77-78. Circumcision May Help Prevent HIV Spread

Emma Hitt, PhD ORLANDO, Florida (Reuters Health) Tue May 28, 2002. Clues Found to Circumcision’s HIV-Protective Effect

Robert Szabo Roger V Short, professor How does male circumcision protect against HIV infection? British Medical Journal 2000;320:1592-1594 and

May, 2000: The Case for Circumcision. East Bay Express. Gordy Stalk Interviews Dr. Edgar J. Schoen and Dr. Daniel Halperin

Contact: Vera Hassner Sharav

Study Says Circumcision Reduces AIDS Risk by 70%
Findings From South Africa May Offer Powerful Way To Cut HIV Transmission
July 5, 2005; Page A1

In a potentially major breakthrough in the campaign against AIDS, French and South African researchers have apparently found that male circumcision reduces by about 70% the risk that men will contract HIV through intercourse with infected women.

Other than abstinence and safer sex, almost nothing has been proved to reduce the sexual spread of HIV, the virus that causes AIDS. World-wide, the major route of HIV transmission for many years has been heterosexual sex.

Vaccine developers have said they would consider an AIDS vaccine with just 30% efficacy useful. But so far, no effective vaccine against the disease has been developed, leaving AIDS workers desperate for another tool to help them stem the tide of new infections, estimated at almost five million last year.

The circumcision findings were so dramatic that the data and safety monitoring board overseeing the research halted the study in February, about nine months before it would have been completed, on the grounds that it would be immoral to proceed without offering the uncircumcised control group the opportunity to undergo the procedure. While men were directly protected from infection by circumcision, women could benefit indirectly because circumcision would reduce the chances their partners would be HIV-positive.

Researchers in the field have been aware of the study’s basic findings, but they haven’t been published, so most experts haven’t evaluated them. The British medical journal the Lancet decided against publishing the study, but for reasons unrelated to the data and scientific content, according to people familiar with the matter. Lancet officials, following standard policy at the journal, refused to comment on why the study was turned down.

The fact that an independent board ordered the study halted is considered a strong sign that the science is sound. Bertran Auvert, the French researcher who headed the trial, declined to discuss the findings but is expected to present them later this month at an International AIDS Society conference in Brazil.

Still, the fact that the research hasn’t yet been published makes experts in the field wary about commenting. “Confirm, confirm, confirm,” said Seth Berkley, a veteran HIV researcher and president of the International AIDS Vaccine Initiative. But if the study holds up, said Dr. Berkley, who wasn’t involved with the research, it would be “quite important” because circumcision would be “an intervention that works over a person’s lifetime and could reduce HIV in a community setting.”

Assuming circumcision is as effective as the new study shows, it would still require careful implementation. In particular, health experts are concerned that men understand that circumcision can’t fully protect them and that they maintain other preventive measures, such as safer sex.

“These preliminary results are quite interesting and we look forward to examining the data more closely, to looking at the technical aspects of the study and public-health implications if these results are confirmed by other trials,” said Cate Hankins, chief scientific adviser to the United Nations AIDS agency, UNAIDS.

More than 30 previous studies have suggested a relationship between circumcision and lower rates of HIV infection. In Kenya, for example, HIV prevalence is much higher among the Luo people, who don’t practice circumcision, than among the Kikuyu, who do.

And there are strong biological theories as to why. For example, a type of cell that HIV targets, called the Langerhans cell, lies close to the delicate underside of the foreskin, whereas the head of a circumcised penis tends to develop a thick layer of outer skin that may armor it against HIV. Another theory: Rather than acting against HIV itself, circumcision may help prevent other sexually transmitted diseases that are known to facilitate the acquisition of HIV.

Despite these theories, no study until now has been able to prove that circumcision reduces the chances of contracting HIV. Longtime advocates of the benefits of circumcision note that performing such a study has always faced resistance because of the sensitive cultural issues involved as well as the challenge of persuading a significant number of men to undergo the procedure.

The new research was designed to test the hypothesis by the most rigorous possible method: a randomized, controlled clinical trial.

It was conducted with more than 3,000 HIV-negative men ages 18 to 24 in a South African township called Orange Farm. Half of the men were randomly assigned to be circumcised and the other half to remain uncircumcised as controls. The study, headed by Dr. Auvert, a researcher at the French National Institute of Health and Medical Research and at the University of Versailles Saint-Quentin, originally planned to follow the men for 21 months. But after all the men had been followed for a year — and about half of them for the full 21 months — the data showed the circumcised group fared far better. For every 10 uncircumcised men in the study who contracted HIV, only about three circumcised men did so, according to two people familiar with the research and a draft of the study reviewed by The Wall Street Journal.

Stopping trials is common when an intervention is clearly shown to be effective. Indeed, the result of the South African trial is likely to spark discussion of whether to halt or modify two other major studies of circumcision and HIV under way in Kenya and Uganda, funded by the National Institutes of Health.

Ronald Gray, lead researcher on the Uganda trial, said, “It would be extremely unwise” to stop the Kenya and Uganda trials at this stage because “medicine has been burned in the past when policy is based on a single trial.”

It isn’t clear how the new study, if confirmed, would influence U.S. policy. Circumcision wouldn’t affect IV drug users who get infected by sharing syringes, a group that accounts for a large proportion of American HIV cases. Also, the South Africa study didn’t evaluate whether circumcision would offer any protection to gay men, who make up another large proportion of American cases. Any direct benefit to gay men would almost certainly be restricted to the insertive partner in anal intercourse, not the receptive partner.

In countries where male circumcision is uncommon and heterosexual HIV rates are high or rising rapidly, the procedure could be a powerful way of reducing the spread of the disease, the new study shows.

Even so, researchers warn of potential pitfalls in trying to put the findings into practice. First, circumcision doesn’t make a person immune to infection. Indeed, if men abandon safer sex practices because they think the surgery completely protects them, then HIV transmission could rise.

“It will not take very much of an increase in risk behavior to overcome the benefit from circumcision,” said Carolyn Williams, an American researcher involved in the Kenya circumcision study. AIDS experts insist that circumcision will have to be accompanied by intensive counseling.

Secondly, AIDS researchers worry that circumcisions performed in unsanitary conditions could lead to dangerous complications.

And while many Africans come from cultures that practice circumcision, many others don’t. Would large numbers of men in noncircumcising cultures consent to go under the knife simply to reduce their risk of acquiring HIV?

“It’s a surgical procedure on an organ that, you know, conjures up a lot of feelings in people,” said Robert Bailey, the principal investigator in the Kenya study. “It’s not just a shot in the arm.”
Male Circumcision Reduces Risk of HIV Transmission From Women to Men
20 Jan 2005

The first study to examine the probability of HIV infection per act of heterosexual sex among a population with multiple sexual partners has found that uncircumcised men have more than twice the risk of acquiring HIV than do circumcised men.

In the study, published in the Feb. 15 issue of The Journal of Infectious Diseases, now available online, Jared Baeten and colleagues from the United States and Kenya collected detailed sexual data from a group of male Kenyan truckers and, using statistical models, developed infectivity measures that estimate the per-sexual-act probability of HIV transmission. The study is the first to calculate the probability of infection for men who have multiple, concurrent heterosexual partners, which was found to be significantly higher than infectivity rates calculated in the past from studies of monogamous couples. Their results may help explain the rapid spread of HIV in settings where circumcision is not common and multiple sexual partnerships are.

Between 1993 and 1997, 745 male employees of trucking companies based in Mombasa, Kenya were followed for the study. Initially they were evaluated for circumcision status and HIV-negativity. Over the length of the study the men were asked to give information concerning the number of sexual encounters with three different partner types–wives, casual partners, and prostitutes–and were screened for HIV and other sexually transmitted infections. At the end of the study the probability of infection was calculated using a statistical model that incorporated published data to estimate the rates of HIV infection among the three types of sexual partners.

For the men in the study, the overall probably of becoming HIV-infected following a single act of intercourse was calculated to be .0063, or one in 160. Uncircumcised men had a more than two-fold increased risk of infection per sexual act compared with circumcised men–one in 80 versus one in 200. Past studies have also found greater HIV infection risk for uncircumcised men. Unlike those studies, however, the present study was also able to take into account cultural characteristics that might be responsible for differences in sexual behavior. These differences could, in turn, account for differences in the risk of infection. But the researchers found that cultural differences in sexual behavior did not matter: when groups of men were excluded from the analysis based on ethnic or religious characteristics, the difference in probability of infection related to circumcision status did not change.

In addition to the results on circumcision, another significant result of the study was the high overall rate of per-contact infection. In past studies that attempted to calculate the probability of female-to-male infection through heterosexual sex, the cohorts consisted only of monogamous couples in which the female partners were HIV-positive. However, in some areas of Africa where HIV infection rates are highest, multiple, concurrent partnerships are more common than monogamous couplings. Past studies of monogamous couples found that the probability of HIV transmission per-act of sexual intercourse was on the order of one in 1000 or less, much lower than the probability of one in 160 found in this study. Taken with the authors’ evidence that female-to-male infection rates may be more than two-fold greater for uncircumcised men, this new information may help us understand why the virus is spreading rapidly in parts of Africa, and help define better HIV strategies for prevention in these settings.

BMJ 2000;320:1592-1594 ( 10 June )

How does male circumcision protect against HIV infection? Robert Szabo, medical resident a, Roger V Short, professor b.

In his otherwise excellent review of the AIDS epidemic in the 21st century, Fauci presented no new strategies for preventing the spread of the disease. 1 He made no mention of male circumcision, yet there is now compelling epidemiological evidence from over 40 studies which shows that male circumcision provides significant protection against HIV infection; circumcised males are two to eight times less likely to become infected with HIV. 2 Furthermore, circumcision also protects against other sexually transmitted infections, such as syphilis and gonorrhoea, 3 4 and since people who have a sexually transmitted infection are two to five times more likely to become infected with HIV, 5 circumcision may be even more protective. The most dramatic evidence of the protective effect of circumcision comes from a new study of couples in Uganda who had discordant HIV status; in this study the woman was HIV positive and her male partner was not. 6 No new infections occurred among any of the 50 circumcised men over 30 months, whereas 40 of 137 uncircumcised men became infected during this time. Both groups had been given free access to HIV testing, intensive instruction about preventing infection, and free condoms (which were continuously available), but 89% of the men never used condoms, and condom use did not seem to influence the rate of transmission of HIV. These findings should focus the spotlight of scientific attention onto the foreskin. Why does its removal reduce a man’s susceptibility to HIV infection?

See complete article

FAIR USE NOTICE: This may contain copyrighted (© ) material the use of which has not always been specifically authorized by the copyright owner. Such material is made available for educational purposes, to advance understanding of human rights, democracy, scientific, moral, ethical, and social justice issues, etc. It is believed that this constitutes a ‘fair use’ of any such copyrighted material as provided for in Title 17 U.S.C. section 107 of the US Copyright Law. This material is distributed without profit.