Heterosexual men who are circumcised are less likely to contract HIV/Aids from their female partners, according to ground-breaking South African research.
In 2002, the scientists recruited more than 3 000 uncircumcised heterosexual men aged 18 to 24 from Orange Farm, a Johannesburg slum where about 32% of women have HIV.
Half these men were then circumcised.
Three years later, 51 of the uncircumcised men were diagnosed with HIV, compared with just 18 of those who had been circumcised.
”It means we prevented six or seven out of a possible 10 infections,” says Bertrand Auvert of the French National Institute of Health and Medical Research (Inserm), who worked with Dirk Taljaard of the Progressus Research and Development Consultancy in Johannesburg. Their work has just been presented at the 2005 International Aids Society conference in Rio de Janeiro, Brazil.
Because of the marked difference between the two groups, and following the advice of the Data Safety and Monitoring Board, part of the Create consortium against TB and Aids funded by Microsoft founder Bill Gates, the trial was stopped and all participants were offered circumcision.
Two similar trials are currently underway in Kenya and in Uganda. Together, they involve another 8 000 men. According to Auvert, an uncircumcised penis is more likely to be infected because the moist environment underneath the foreskin helps the virus — and other organisms that cause sexually transmitted diseases — survive and reproduce.
The Joint United Nations Programme on HIV/Aids says the results of these trials are important to clarify the relationship between circumcision and HIV.
UNAids adds that the results of the South African trial ”must be considered in the context of the cultural acceptability of promoting circumcision, the risk of complications from the procedure, the additional risk associated with circumcisions performed under unhygienic conditions, and the potential to undermine existing protective behaviours and prevention strategies that reduce the risk of HIV infection.”
In a joint statement, three UN bodies, including UNAids and the World Health Organisation warned that even if male circumcision is confirmed to reduce the risk of acquiring HIV, this does not mean that circumcised men are risk-free.
Charles Gilks, of the WHO’s HIV/Aids department, says he is concerned that men might rush to get circumcised in unsafe procedures and subsequently abandon other precautions in sexual intercourse, such as using condoms.
Also at the IAS conference, Rebecca Stallings, of the US Macro International Research Corporation, presented a study of female circumcision.
The trial involved 7 154 HIV positive women in Tanzania. According to Stallings, female circumcision appears to increase the risk of women being infected with HIV.
She says this is because the surgery itself increases the vulnerability of the genital skin.
In addition, says Stallings, circumcised women are more likely to have anal intercourse, which also increases the chances of infection.
The British-based Lancet medical journal last year published the results of a study in India that suggested there was a link between circumcision and lower HIV infection rates as ”Aids risk ‘cut by circumcision’.”
Unlike the South African trial however, the Indian study did not randomly circumcise half the participants. Rather, the researchers observed whether already circumcised men were more or less likely to become infected with HIV.
The Lancet decided against publishing the South African study. According to a report in The Wall Street Journal online, this was ”for reasons unrelated to the data and scientific content”. The Lancet, following its standard policy, declined to explain it chose not to publish the study.
Meanwhile, efforts to treat and prevent HIV/Aids will fail if the gap between scientific discovery and health policy is not narrowed, said researchers at the same conference. Delegates at the 2005 International Aids Society conference were told that responses to the pandemic should be modified quickly in line with new research.
”Scientific findings presented at this conference highlight the urgency of applying what we learn,” said Craig McClure, executive director of the International Aids Society. ”This is a rapidly evolving virus and epidemic and we need to stay ahead of it.”
IAS president Helene Gayle added that ”scientific knowledge alone will not end the pandemic, we need bold political leadership to translate science into policy, and policy into practice”.
These sentiments were echoed by Stephen Lewis, the UN Special Envoy for HIV/Aids in Africa, who said: ”Despite important progress in recent years, we have failed to ensure that the benefits of science … in particular, state-of-the-art treatments and effective prevention services, reach the most impoverished areas of the world.”
Charlie Gilks, of the World Health Organization’s HIV/Aids department called for a new alliance between the scientific community and those living with HIV/Aids, as well as between companies that develop new drugs and those that make ‘generic’ versions of existing ones.
”We need to move new products and approaches into the field very quickly,” said Gilks.
He noted that HIV/Aids was a huge challenge, but that there was a growing body of science to help to combat it.
”There is no other field where the opportunities to translate evidence into action are so great,” said Gilks.
”Not only can researchers directly impact on policy and practice, they have a real opportunity to reduce the inequity between those who usually benefit from science and those who do not.”
Mauro Schechter, who heads the Aids programme at Brazil’s Federal University of Rio de Janeiro and is co-chairing the conference, said that increasing access to life-saving HIV drugs in developing countries had emerged as a global imperative.
”Equally important are the goals of ensuring access to proven prevention methods and disseminating important scientific research that is taking place all over the world, including here in Brazil,” he added. — SciDev.Net