Circumcision Safe In HIV Positive And Negative Men

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Main Category: HIV / AIDS
Also Included In: Sexual Health / STDs;  Men's health;  Public Health
Article Date: 02 Jun 2008 - 17:00 PDT

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It is safe to perform circumcision on HIV-infected men if the disease is not in its advanced stage, according to an article released on June 2, 2008 in the open access journal PLoS Medicine.

One of the major forms of transmission of HIV in Africa is through sex without a condom. Previously, three separate trials in South Africa, Kenya, and Uganda have shown that circumcised men were only half as likely as uncircumcised men to contract HIV from infected females during intercourse. As a result, male circumcision is encouraged as a means of stifling HIV transmission, even though it cannot provide complete protection. However, the safety of the circumcision procedure has not yet been tested in HIV-infected individuals.

To measure the safety of this procedure in HIV positive men, two clinical trials of circumcision were performed in the rural Rakai district of Uganda by Ron Gray of the Bloomberg School of Public Health, Johns Hopkins University and colleagues. In each trial, men who showed no symptoms of HIV infection, and with normal CD4 T-cell counts, were circumcised and tracked for complications. They found that under optimal surgical conditions, both HIV-positive and HIV-negative patients had approximately a 3% rate of moderate or severe surgical complications, usually in the form of infections. However, HIV-infected men showed a longer healing time, and a higher risk of complications if they resumed sexual intercourse before this wound healing process was complete.

This study not only shows a promising future for the circumcision of HIV-positive men to help curb the HIV/AIDS epidemic in Africa, but also indicates that less screening may be necessary before this procedure. If men are not showing symptoms of HIV-infection, screening for the disease should not be required for the procedure to be performed, assuming the patient waits until he is completely healed (sometimes six weeks or longer) to resume intercourse. This should reduce the complexity of the procedure, and reduce the stigma of community exclusion, thus making the process more accessible to men in this situation.

Another analysis from one of these trials, which was reported separately, found that the female partners of men who resumed intercourse before healing were more likely to contract HIV. This underscores the importance that men undergoing the procedure wait the full recovery period before resuming regular sexual activity.

The safety of adult male circumcision in HIV-infected and uninfected men in Rakai, Uganda.
Kigozi G, Gray RH, Wawer MJ, Serwadda D, Makumbi F, et al.
PLoS Med 5(6): e116.
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Written by Anna Sophia McKenney
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