Sunday, November 29, 2009

Reasons for decreased risk of HIV infection in circumcised men

There is an interesting comment on this post.

http://www.sciencedaily.com/releases/2009/11/091123212540.htm

ScienceDaily (Nov. 24, 2009) — The decreased risk of HIV infection in circumcised men cannot be explained by a reduction in sores from conditions such as herpes, according to research published in PLoS Medicine.

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The researchers found that reduction in symptomatic genital ulcer disease accounted for only about 10% of the protective effect associated with circumcision, and did not find any consistent role for HSV-2 in counteracting protection. These results indicate that most of the reduction in HIV acquisition provided by male circumcision may be explained by the removal of vulnerable foreskin tissue containing HIV target cells. They also suggest that circumcision reduces genital ulcer disease primarily by reducing the rate of ulceration due to causes other than herpes, including sores caused by mild trauma during intercourse.
Posted by Patricia at 5:57 PM
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2 comments:

Mark Lyndon said...

Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

It's not like we've actually tried the things that do work. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn't refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they'd be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.

Meanwhile, AIDS killed an estimated 2 million people worldwide in 2007, but an estimated 3.5 million children die each year from diarrheal diseases and pneumonia.

6:59 AM
Patricia said...

All good points.

I don't think most people would consider something like circumcision to be some kind of magic vaccine. I expect it would be part of a multi-pronged approach. Admittedly, some people are not scientifically minded.

To know whether circumcision has an effect one way or the other, we would have to look at groups of men that were matched as closely as possible. Eg., different religions in some areas might be associated with both different rates of circumcision, and different rates of visiting prostitutes, using condoms, etc.

4:30 PM

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