Research recently conducted in Kenya and Uganda is said to show conclusively that circumcised men are half as likely to become infected with the HIV virus through heterosexual sex than non-circumcised men. This confirms the findings of an earlier trial in South Africa which showed a 60 per cent reduction in HIV infections in circumcised compared to non-circumcised men.
This may partly account for the different rates of spread of HIV throughout Africa, where routine circumcision varies widely.
The research was sponsored by The Canadian Institutes of Health Research (CIHR) and the The US National Institutes of Health (NIH).
It is thought that circumcision protects men against HIV because the male foreskin, which is mostly removed by circumcision, offers a way into the body for the virus. It is lined with Langerhans’ cells which act as receptors for HIV, and the lining is prone to tiny scratches and tears that can also become infected.
It is possible that a similar theory applies to HIV infection in women since the clitoris and labia are also lined with Langerhans’ cells. The question of whether the reduced infection rate in African men will lead to lower infection rate in African women is the focus of a separate project, sponsored by the Bill and Melinda Gates Foundation and due to complete in two years.
While the research is conclusive, implementation in practice is messy and full of risk. Can sufficient African men, bound by wide ranging ethnic and cultural traditions be persuaded to become circumcised? How easy will it be to get male infants circumcised? Some scientists are suggesting that in Africa, some populations are already increasing routine male circumcision.
Also, it is important that this new message gets across clearly. Circumcision does not eliminate HIV infection, it merely reduces the likelihood of infection, albeit significantly, and men will still need to use condoms. But if the message gets across badly, they could stop using condoms thinking that circumcision gives total protection and this could turn into a general message that condoms are ineffective.
The cost of mass scale circumcision programmes will also be vast, but in comparison to the present alternative, which is to treat HIV post-infection, it is not. Again, it is a matter of who pays and whether it will be enough.
Also, circumcisions can go wrong – they become infected and cause further healthcare and social problems.
Plus, there still remains the issue of HIV transmission through infected needles and anal-receptive sex.
The war against HIV/AIDs is complex, and success will depend on the careful management of different strategies, all working together. It now rests with policy makers to take this new data and make it work, on the ground.
Click here for HIV/AIDs articles on Development in Practice (Oxfam).
Written by: Catharine Paddock
Writer: Medical News Today