Circumcision and prevention of HIV

By Kumudini Hettiarachchi

Male circumcision, research has shown, prevents the transmission of the Human Immuno-deficiency Virus (HIV), announced Dr. Paolo G. Miotti of the Office of AIDS Research, US National Institutes of Health.

Three clinical trials, the earliest one in South Africa, and the other more recent ones in Uganda and Kenya have indicated the same result, he told MediScene, after addressing a plenary session of the 8th International Congress on AIDS in Asia and the Pacific held in Colombo last month.

Those who were circumcised were 50-60% less likely to catch the virus, he said, explaining that there may be several reasons for this. "Cutting away the foreskin of the penis takes away the receptacle for the virus to grow. It makes the area cleaner and there is less chance for the virus to sit around," he said.

Describing the details of the clinical trials in Uganda and Kenya, Dr. Miotti said, the two groups, similar in behaviour and many other variables, in both countries were the "interventional group" which was circumcised and the "control group" which was not circumcised. There were fewer infections in the first group.

"Fewer enough to make a difference," he stressed, adding that the findings were published in the Lancet, the respected British medical journal.

Male circumcision is the surgical removal of some or all of the foreskin or prepuce from the penis. Compared to 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 in laboratory studies, MediScene learns.

The foreskin may have greater susceptibility to tears during intercourse, providing an entry point for the virus. The World Health Organization, however, has reacted with caution, to these findings on male circumcision calling it a "significant scientific advance" recommending it only in a controlled situation.

Dr. Miotti also stressed that where and how the circumcision is done would also be a significant factor in the prevention of infection. Pointing out the problems that could arise, he said in the clinical trials, the operating room was sterile, but these conditions may not be reproduced elsewhere. "Then the male undergoing circumcision could be vulnerable to infection."

The equipment such as blades and gloves may not be very clean. The facility where it is being performed may not be sterile. The person undergoing circumcision may also bleed, he said, dealing with the problems that could crop up. "For this minor procedure, a doctor is not needed but trained personnel will be vital," he said adding that circumcision is done under local anaesthesia and some remote areas may not have access to the anaesthetic.

Underlining the need for more research, Dr. Miotti came out with a strong warning that male circumcision cannot be taken as a "behavioural disinhibition" or "risk compensate", adding that it is just another prevention strategy. Circumcision is not a vaccine against HIV. Men must not think that it is a surgical condom which gives them the freedom to indulge in risky sexual behaviours, he added.