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Saturday, November 18, 2017

Does circumcision prevent HIV?

by Adam (writer), Clermont Ferrand, February 12, 2007

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Circumcision is the ablation of the penile foreskin which covers the glans. It may involve physicians or nurses for medical purposes like phimosis, penile cosmetic surgery or cancer, but it was first practiced for religious reasons, essentially by the Jews and Muslims.
HIV was discovered in 1986 among the gay community of San Francisco and is now a global health problem with 4.1 million new cases/year and 2.8 million deaths/year.
It has massively spread in Asia and Sub-Saharian Africa.

The hypothesis that male circumcision could protect from HIV infection is mentioned in several scientific publications since the very beginning of the epidemic (Fink AJ. A possible explanation for heterosexual male infection with AIDS. N Engl J Med. 1986;315:1167). None of these publications have, until now, shown evidence of the protection acquired from this practice.

In november 2005, Bertran Auvert, a French specialist of infectious diseases from the Ambroise Pare Hospital, published a randomized and controlled trial in which more than 3000 young uncircumcised men, aged 18-24 years old, where divided into two groups, equivalent for all measurable variables. In the first one, subjects where circumcised and the second group was considered as control.
after a 21 months follow-up, there were 21 HIV infections in the intervention group and 49 in the control one.
These results seem to indicate a protective effect against HIV sexual infection of 60%.

This trial is the first to find out scientific evidence of circumcision effects on HIV infection but it also raises economical, medical and ethical problems that need to be solved before setting this procedure as a public health practice.

Citation: Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Med 2(11): e298.


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Adam is a writer for BrooWaha. For more information, visit the writer's website.
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9 comments on Does circumcision prevent HIV?

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By E Jo on February 12, 2007 at 05:40 pm
They should have given the 3000+ subjects condoms! Interesting study, I'd like to know more. However, not a great way to prevent HIV...
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By E Jo on February 12, 2007 at 08:29 pm
El G, not only are you politically inclined but you are well versed in bloodborne infectious disease transmission too. You bring up some excellent questions and valid reasons to question this research. Until there is a vaccine available (if ever) I would not put too much credence to the claims of this research. The ability of latex condoms to prevent transmission has been scientifically established in laboratory studies as well as in epidemiologic studies of uninfected persons at very high risk of infection; consistent use of a latex condom provides a high degree of protection between heterosexual transmission of HIV. Hold off on the circumcision, buy condoms (or abstinence if you prefer?).
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By V on February 13, 2007 at 02:12 am
When I first heard about this, it stopped me in my tracks for a moment. I have always been very strongly decided that should I have a son, there's no way on earth that I'd have him circumcised. By the same token, I would naturally want to give him every opportunity in my power to diminish the chances of him ever contracting HIV. They seriously need to do more research on this one, but just the though that there's a chance that circumcision could reduce risk, has been enough to shake my once solid stance ...
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By Adam on February 13, 2007 at 03:31 am
first of all, i would you like to thank everyone of you for reading this article. I may developpe some points to answer your questions if i can: 1/ the authors have never denied that condom use is at this moment the best method for preventing HIV spread. However in developped nations its use is poorly accepted for social, religious and economic reasons. Male circumcision should not be considered as an absolute protection against HIV but as a way to reduce the infection rate among people who are not using any protection. In this study, condom use was a controlled variable but not forbidden. 2/ This study is the first that includes male circumcision within its protocole and thus control most of common biais. Condom use, ethnical and religious beliefs, sexual behaviour and health-seeking behaviour were controlled. 3/ This study was not limited to heterosexual transmission of HIV but male homosexuality is very taboo in Africa and thus difficult to analyse without biais. Several cross-sectionnal studies have analysed the effect of male circumcision on HIV within "men having sex with men" in Africa and have shown similar results, even if these studies are not controlled for pssible biais. (Siegfried N, Muller M, Deeks J, Volmink J, Egger M, et al. HIV and male circumcision—A systematic review with assessment of the quality of studies. Lancet Infect Dis. 2005;5:165–173) 4/ The negative aspects of this study is that it can promote risky sexual behaviours among circumcised men. It can also be an argument for female circumcision promoters. Last, it can accelerate HIV spread in countries in wich hygiene conditions are poor and sterilisation nearly inexistant. 5/ Every point of view should be respected but female circumcision is a practice that have not shown any medical interest and should not be compared to male circumcision that have others benefit that we can discuss later and is also, in most cases, harmless. 6/ Two others studies of the same type are currently carried. I hope i can report their results soon. Thanks again for your interest and comments. Feel free to ask other questions if you want to. I'll try to answer the best that i can...
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By TLCTugger on February 13, 2007 at 08:53 am
^^ HIV was discovered in 1986 among the gay community of San Francisco ^^ Another sign that the Africa study lacks merit; over 450,000 US men who were cut at birth have died of AIDS. AIDS is more rare in non-cutting Japan than it is in 95%-cut Israel. Even in Africa, Cameroon, Lesotho, Ghana, Rwanda, Tanzania, and Malawi have higher HIV incidence among the cut than among the intact. When a study has no real-world predictive ability, it is a sure sign of unaccounted for confounders in the population, the analysis, or in the experimentor. The South Africa study involved telling the cut men to abstain for a while and to be certain to use condoms due to their open wound. The intact men got no such counsel.
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By Adam on February 13, 2007 at 04:27 pm
In response to TLCTugger, I knew when i wrote this article that it would be controversial, as circumcision itself for any reasons it may be practiced. I'm not hoping that everyone will agree with my opinion that circumcision, performed by trained practitionners, can be useful to public health, especially in emerging countries. Nevertheless, i can't let you write that there is more HIV infections among circumcised men when almost all the cross-sectionnal studies led in Africa and India seem to demonstrate the contrary, even with possible biais. I invite you to report to Siegfried article that has been publihed in the Lancet in 2005 But i'm afraid it will not help to make up your mind if you already did before reading it... Siegfried N, Muller M, Deeks J, Volmink J, Egger M, et al. HIV and male circumcision—A systematic review with assessment of the quality of studies. Lancet Infect Dis. 2005;5:165–173
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By nanouch on February 13, 2007 at 08:11 pm
ben dis donc mon fils!!!!!impressionant,,,,,j'ai des enfants c'est des génies!!!vivement le prix nobel,,,, j'espère que tu vas bien ds ton trou du massif central,envois moi un pti mail Adam jewish mother
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By mrng on March 28, 2007 at 02:17 pm
If the reason for transmitting HIV from uncircumcised men is due to not cleaning under the foreskin then it would make more sense to educate on cleanliness rather than cutting-off the foreskin of all males. It is a very painful procedure for adults and practically torture when done to infants. This logic would dictate that circumcision of women, now usually referred to as "genital mutilation", is in order too since there are studies indicating 'circumcised', meaning the removal of the labia minora, etc., results in lower HIV infection rates as well as lower rates of cancer of the vulva. If one wants to read the results of studies and comments re the purported studies supporting the circumcision of men to prevent AIDS then go to: http://www.doctorsopposingcircumcision.org/info/HIVStatement.html There are always two sides and I think there is much, much more credible evidence against circumcising males to prevent HIV infection.
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By Adam on April 04, 2007 at 05:33 am
In response to mrng, male circumcision has been studied in 3 different trials in wich it has shown scientific evidence of reducing HIV-1 and HIV-2 female to male transmission in heterosexual vaginal intercourse. this protection is estimated to 60% and male circoncision is now recommended by the WHO this new prevention strategy can help decreasing HIV incidence in association whith the other well known prevention strategies already applied, as condom use or systematic treatement of sexually transmitted diseases, and of course education and counselling. And these non interventionnal strategies should not be neglected. Secondly, male circoncision can't be compared to female circoncision wich is effectively the ablation of labia minora and clitoris. this practice can result in severe genital (procreation difficulties, dyspareunia) and urological (dysuria) disorders. It hasn't shown any interest in HIV prevention nor genital cancer in any randomised trial. Male circoncision, even if it can be painful, is a safe practice and has a complication rate of less than 5% if done by trained practitionners.
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