WASHINGTON - Circumcising adult men may reduce by half their risk of getting
the AIDS virus through heterosexual intercourse, the US government announced
Wednesday, as it shut down two studies in Africa testing the link.
A man is seen with an AIDS awareness
message painted on his head in January 2006. Circumcision significantly
reduces the risk of contracting the AIDS virus, according to two new
studies released and that could have significant implications in the fight
against the deadly disease. [AFP]
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The National Institutes of Health closed the studies in Kenya and Uganda
early, when safety monitors took a look at initial results this week and spotted
the protection. The studies' uncircumcised men are being offered the chance to
undergo the procedure.
The link between male circumcision and HIV prevention was noted as long ago
as 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.
Still, many AIDS specialists had been awaiting the NIH's results as a final
confirmation.
"Male circumcision can lower both an individual's risk of infection, and
hopefully the rate of HIV spread through the community," said AIDS expert Dr.
Anthony Fauci, director of the NIH's National Institute of Allergy and
Infectious Diseases.
But it's not perfect protection, Fauci stressed. Men who become circumcised
must not quit using condoms nor take other risks - and circumcision offers
no protection from HIV acquired through anal sex or injection drug use, he
noted.
"It's not a magic bullet, but a potentially important intervention," agreed
Dr. Kevin De Cock of the World Health Organization.
Male circumcision is common at birth in the United States. But in sub-Saharan
Africa, home to more than half of the world's almost 40 million HIV-infected
people, there are large swaths of populations where male circumcision is rare.
The WHO plans an international meeting early next year to discuss the
studies' results and how to translate them into policies that promote safe male
circumcision - done by trained health workers with sterile equipment -
while teaching men that it won't make them invulnerable.
If male circumcision were widely adopted, officials predicted that could help
to avert tens of thousands of HIV infections in coming years; Fauci cited one
model from South Africa that suggested possibly up to 2 million infections could
be averted over a decade.
"This is tremendous news, and it could help millions of men while in turn
reducing the risk faced by millions of women," said Paul Zeitz of the Global
AIDS Alliance.
Why would male circumcision play a role? Cells in the foreskin of the penis
are particularly susceptible to the HIV virus, Fauci explained. Also, the
foreskin is more fragile than the tougher skin surrounding it, providing a
surface that the virus could penetrate more easily.
Researchers enrolled 2,784 HIV-negative men in Kisumu, Kenya, and 4,996
HIV-negative men in Rakai, Uganda, into the studies. Some were circumcised;
others were just monitored.
Over two years, 22 of the circumcised Kenyans became infected with HIV
compared with 47 uncircumcised men, a 53 percent reduction. In Uganda, 22
circumcised men became infected vs. 43 of the uncircumcised, a 48 percent
reduction.
The researchers are offering all of the studies' uncircumcised men the chance
to undergo the procedure, and 80 percent of the uncircumcised Ugandans already
have agreed, said lead researcher Ronald Gray of Johns Hopkins University.
Side effects were rare, including some mostly mild infections that were
easily treated. The rate of side effects was comparable to those seen in
circumcised US infants, said Robert Bailey of the University of Illinois at
Chicago, who led the Kenyan trial.