Why circumcision reduces HIV risk

Nov 24, 2009

The decreased risk of HIV infection in circumcised men cannot be explained by a reduction in sores from conditions such as herpes, according to research published in PLoS Medicine.

In further analyses of data from 2 clinical trials including more than 5,000 men in rural Uganda, which had shown that circumcision reduced the risk of HIV in men by about 60%, Ron Gray of the Johns Hopkins Bloomberg School of Public Health and colleagues investigated factors associated with that reduction in risk. Specifically, they investigated whether infection with HSV-2, the virus that causes genital , and whether genital ulcers of any cause, could account for the lower rates of in the circumcised study participants.

The researchers found that reduction in symptomatic genital ulcer disease accounted for only about 10% of the protective effect associated with circumcision, and did not find any consistent role for HSV-2 in counteracting protection. These results indicate that most of the reduction in HIV acquisition provided by male circumcision may be explained by the removal of vulnerable foreskin tissue containing HIV target cells. They also suggest that circumcision reduces genital ulcer disease primarily by reducing the rate of ulceration due to causes other than herpes, including sores caused by mild trauma during intercourse.

More information: Gray RH, Serwadda D, Tobian AAR, Chen MZ, Makumbi F, et al. (2009) Effects of Genital Ulcer Disease and Herpes Simplex Virus Type 2 on the Efficacy of Male Circumcision for Prevention: Analyses from the Rakai Trials. PLoS Med 6(11): e1000187. doi:10.1371/journal.pmed.1000187

Source: Public Library of Science

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User comments : 2

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sender
not rated yet Nov 24, 2009
Strange one would think that removing foreskin would increase penile friction leading to greater microfractures. I wonder if they used prostitutes to ensure proper percentages and ruled out social dynamic factors.
ml66uk
not rated yet Nov 24, 2009
Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw. This is not the first time that HIV in women has been linked to circumcision of their partners.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.