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

July 17, 2009 |  2:21 pm

Morecondoms 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