Women, don't count on male circumcision to protect against HIV

Obviously, men shouldn't bank on circumcision to keep them safe either. But the results of a study released this week are especially disappointing for researchers who'd hoped it might reduce HIV transmission to women, thus helping fight AIDS in Africa. 

The premise was promising. Earlier research had indeed suggested that male circumcision might reduce the risk of transmission to the female partners of HIV-positive men.

That seems not to be the case.

The new study, of 922 Ugandan men with the virus, found that the female partners of circumcised participants were no less likely to contract the disease than the female partners of uncircumcised participants.

The removal of the penile foreskin does seem to protect men against HIV transmission from female partners. Just not women at risk from men.
 
Here's a summary of the study, published today in the Lancet.

Its interpretation is very straightforward: "Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention."

The report notes, "The trial was stopped early because of futility."

Here's a more readable story on the findings, courtesy of Reuters news agency.

And here's a fact sheet from the Centers for Disease Control and Prevention on male circumcision and HIV transmission. Of special note are the biological reasons that circumcision has been such a focus of concern:

Compared with the dry external skin surface, the inner mucosa of the foreskin has less keratinization (deposition of fibrous protein), a higher density of target cells for HIV infection (Langerhans cells), and is more susceptible to HIV infection than other penile tissue in laboratory studies. The foreskin may also have greater susceptibility to traumatic epithelial disruptions (tears) during intercourse, providing a portal of entry for pathogens, including HIV. In addition, the microenvironment in the preputial sac between the unretracted foreskin and the glans penis may be conducive to viral survival. Finally, the higher rates of sexually transmitted genital ulcerative disease, such as syphilis, observed in uncircumcised men may also increase susceptibility to HIV infection.

-- Tami Dennis

Photo: Use them -- if you can get them. Credit: Bryan Chan / Los Angeles Times

Comments

[anne marie teters]

It's so ridiculous! The 'scientific' experiment that shows that circumcision helps reduce HIV transmission doesn't consider the fact that the men that underwent circumcision also received counseling about HIV transmission, were told to abstain from sex for six weeks and were given access to condoms...something their uncircumcised peers did not receive. HIV virus is found in bodily fluids: in the case of sexual transmission, semen ..and to a less degree, vaginal fluids, cause HIV transmission. This has NOTHING to do with foreskin.

[Mike Ruffner]

This seems to be another case of science eventually proving what any rational person already knew. So how many of these 922 Ugandan test subjects (and there companions) are now infected? But maybe if they had used 922 researchers they might have reached the same conclusion much earlier.

[stanley chin wang]

One more time the psycho-sexual forces have been proven wrong by one of their own. The claim the circumcision could in anyway impact the the transmission of infected bodily fluid to another person has been dis-proven by one of the procedures biggest supporters.

They have reached the obvious and simplest conclusion, HIV-AIDS is a blood disease transmitted by blood plasma. This is again another cruel joke perpetrated on the people of Africa by uncaring Americans. The sad thing is that the the majority of US science was opposed to this concliusion and recommended a "wait and see" position. Unfortunately, the religious zealots, both Christian and Hebrew, pushed their case successfully.

Bill and Melinda Gates have been soaked of precious money that could have been better used for condoms and education.

[Hugh Young]

They stopped the study because it was "futile", but they say "don't stop circumcising, it works"? Something is very wrong here. In fact many things are wrong. Another reading of this story is "Circumcision INcreases HIV transmission to women by 50%". And women are already at greater risk.

The proposition that women will be protected indirectly is pure surmise. So is the proposition that early resumption of sex is the reason for the greater infection. An alternative hypothesis is that circumcised men's keratinised (hardened) glanses (and their rougher action as they tried to get the stimulation they were used to, but with ~20,000 fewer nerve-endings) create microtears in the women's vaginas, making transmission easier. But they won't be considering that, because it doesn't suit their agenda.

[Steve]

Wow. According to that new study, circumcised males are 50% more likely to transmit HIV to women.

[penske]

If circumcision reduces the risk of men contracting HIV, then that is fewer people with HIV and therefore fewer women will contract the disease. A big problem with studies such as this is that it highlights 'Circumcision doesn't reduce transmission of HIV from infected men to women' - so some people might see that as circumcision having no effect at all, and therefore not getting one for themselves or their children.

Circumcision DOES reduce the chance of a man contracting HIV from women.

Less men with HIV ----> Less women with HIV

Circumcision is a good idea. Period.

[Joseph]

"If circumcision reduces the risk of men contracting HIV, then that is fewer people with HIV and therefore fewer women will contract the disease."

Is this why the women got HIV?

"A big problem with studies such as this is that it highlights 'Circumcision doesn't reduce transmission of HIV from infected men to women' - so some people might see that as circumcision having no effect at all, and therefore not getting one for themselves or their children."

No, the bigger problem is that these studies avoid admitting that circumcision makes the problem worse.

It's only a "problem" for those to whom it is more important to legitimize circumcision than it is to reduce HIV transmission.

There's nothing that horrifies circumcision advocates more than an implication that their snake oil is not totally indispensible.

Penske, could you tell us why STD prevention is relevant in newborns and children that do not have sex? The "studies" in Africa involved grown making decisions. Could you tell us why chidlren couldn't grow up to weigh the "pros and cons" of circumcision for themselves? Could it be because much to your dismay they would choose the more effective method of condoms for STD prevention vs. being circumcised, which would only protect them 60% of the time, which means they'd still have to wear condoms?

"Circumcision DOES reduce the chance of a man contracting HIV from women."

This claim hasn't exactly been proven. Even if the "studies" used to make this stamement were correct, they prove that circumcision conclusively FAILS "40% of the time." A condom that only protected 40% would never be sold out on the market. Truly, it would be a crime to do so.

"Less men with HIV ----> Less women with HIV"

This is based on the dubious premise that circumcision prevents against HIV. It does not.

Penske, type it on here. Confirm it for the readers?

Does circumcision immunize a man against HIV? Or does it not?

It does not. This is why there are more men with HIV in circumcising America, than there are in non-circumcising UK.

Which, by the way, did you know that most of the countries in Africa where HIV is prevalent already practiced circumcision?

Basically, HIV funds are paying them for something they already did, while making people like Bill and Melinda gates seem "cheritable," and making "scientists" that were already long-standing advocates of circumcision seem "innovative."

"Circumcision is a good idea. Period."

Speak for yourself. Whether circumcision "protects" or not, whether it "reduces the chances of HIV" or not, this is a choice for a grown, sexually active man to make. Circumcising babies and children who are at zero risk is a violation of their individual human rights.

[Jack]

The big news here is that circumcision results in a higher risk of male to female HIV transmsision. This is an equal rise and fall of risk if you buy into the Africa circumcsion studies. If such is true, there is no reason to ask men to give up their main male pleasure zones (20,000 fine touch and stretch pleasure sensing nerves). This shows this is a total waste of resources.

[Jack]

Hey penske.

This study shows that circumcision Circumcision DOES increase the chance of a woman contracting HIV from men (by about 50 5).

More women with HIV ----> more men with HIV

Also, men lose their main plesure zones. It is much less fun having sex with a condom cut. A fact (20,000 errogenous nerve endings).
Circumcision is a such a BAD idea. Period.

[Sofronio]

You'll cut off my foreskin when you can pry it out of my cold dead hands! LOL! Guys who promote circumcision just want to feel better about a missing body part-- or are promoting a tradition of their religious beliefs. Last time I checked, most religions had rules about lying and stealing. Which is exactly what circumcision is. Lie: circumcision improves [fill in the blank]. Stealing: infant circumcision. If you feel bad about being cut, then stop trying to trick others into doing it so you can somehow justify your own loss. Two wrongs do not make a right. Oh, and be safe. Wrap that thang up before you do it. Condoms prevent AIDS, not assaulting and harming a man's sex organ.