Circumcision Reduces HIV Rates, U.S. Studies Confirm

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Circumcision Reduces HIV Rates, U.S. Studies Confirm

WEDNESDAY, Dec. 13 (HealthDay News) -- U.S. researchers in Africa said

Wednesday that they found that circumcision is such a good defense against HIV

infection that they shut down two studies early, and instead offered all

participants a chance to be circumcised.

One study in the east African country of Kenya showed that circumcision cut

adult males' HIV infection risk from heterosexual intercourse by 53 percent,

while another study in Uganda lowered the risk by 48 percent, according to

results released Wednesday.

The findings, financed by the U.S. National Institutes of Health (NIH), pointed

out that the latest conclusions confirmed previous investigations into the value

of circumcision as a protection against HIV, the virus that causes AIDS. This is

especially important in Africa, where AIDS is an epidemic in many countries,

infecting an estimated 25 million people on the continent.

Despite the good news, there is still plenty of reason for caution, AIDS experts

said.

" Male circumcision is a difficult intervention to implement, and the

preventive effect is relative, not absolute, " said Coates, an AIDS

specialist and a professor of medicine at the University of California at Los

Angeles. " The magnitude of effect is 50 to 60 percent, which still leaves ample

room for people to get infected with HIV. "

There are other caveats as well: The study did not look at male-to-female

transmission, and it was also not clear whether circumcision makes it less

likely that gay men could transmit HIV to each other.

In the United States, homosexual transmission of HIV is more common than

heterosexual transmission, the experts said. And most men in the United States

are circumcised, making the procedure less effective as a possible prevention

tool.

Still, the findings could have plenty of meaning in Africa, where HIV is

commonly spread between men and women.

Studies have suggested the value of circumcision in the past, but

researchers wanted to confirm the previous findings.

According to the NIH, most adult Africans are circumcised, but the rate drops

below 20 percent in some areas of southern Africa where HIV and AIDS are common.

In one of the two studies, researchers enrolled 2,784 HIV-negative,

uncircumcised men in Kenya beginning in 2002. The other study, in Uganda,started

in 2003 and enrolled 4,996 HIV-negative, uncircumcised men.

Some of the men were assigned to immediately undergo circumcision, while others

had to wait two years.

Then researchers studied whether the circumcision had any effect on their rates

of getting HIV.

The results were so encouraging that an oversight board halted the studies this

week, and ordered that all participants be given circumcisions instead of having

to wait.

In Kenya, researchers found that only 22 of the 1,393 circumcised men in the

study were infected with HIV, compared to 47 of the 1,391 men who had yet to be

circumcised.

The numbers for Uganda weren't immediately available.

" Circumcision is now a proven, effective prevention strategy to reduce HIV

infections in men, " , a study investigator and professor of

epidemiology at the University of Illinois at Chicago, said in a statement.

It's not entirely clear how circumcision reduces HIV infection. But

researchers have suggested that the foreskin may provide a moist, safe

environment for the AIDS virus and provide more immune cells for HIV to infect.

Coates called the study results the " second greatest finding in HIV

prevention, " right behind research that confirmed drugs could stop

mother-to-baby transmission of the AIDS virus.

Still, he added, " combination prevention " remains crucial -- combining

circumcision with using condoms, reducing sexual partners, and delaying the

first time people have intercourse.

The *Associated Press* reported that the link between male circumcision and HIV

prevention was first noted in the late 1980s. The first major clinical trial, of

3,000 men in South Africa, found last year that circumcision cut the HIV risk by

60 percent.

*More information*

The Nemours Foundation's Web site discusses the pros and cons of

circumcision<http://www.kidshealth.org/parent/system/surgical/circumcision.html>

http://www.forbes.com/forbeslife/health/feeds/hscout/2006/12/13/hscout600122.htm\

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