Circumcision Lowers HIV Risk, But Not Popular Among At-Risk African Men
Two reports presented at the International AIDS Conference yesterday showed that circumcised men had a lower rate of HIV. One study found that circumcised males living in a South African community had lower rates of HIV compared with other men in the same community. Another study out of Kenya revealed that, 66 months after circumcision, adult males were less than half as likely as other men to become infected with HIV.
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The South African study began with a circumcision program in Orange Farm in 2008. The program included free circumcision as well as condoms and safe-sex counseling. Three years later the number of circumcised men jumped from 17 percent to 54 percent, and the HIV rate fell from 15.4 percent to 12.3 percent. Physician Bertran Auvert, who worked on the project, said that 1,040 HIV cases were avoided. He said the program should translate into reduced infection rates among women as well, but that "it's the beginning of the story, so we'll need some time."
A similar study conducted by the National Institutes of Health in the U.S. declared in 2006 that circumcision cuts HIV risk by half. The study involved 8,000 African men who were divided into circumcised and uncircumcised groups, given safe sex counseling and retested regularly. The data collected in Kisumu, Kenya during the 2006 study was re-examined as part of the 2012 report presented at the IAC.
The decreased risk has to do with the biology of the penis, particularly the foreskin. The underside of the foreskin contains a high concentration of Langerhans cells, immune system cells known to attach to the HIV virus and aid its transmission throughout the body. The foreskin is also susceptible to minute cuts during intercourse, allowing HIV to enter the bloodstream.
Despite the promising signs of circumcision, it is failing to catch on as quickly as international organizations would like. AVAC, a global advocacy group for AIDS prevention, said it appears unlikely that the international community's target goal of circumcising 20 million African men by 2015 will be reached. The World Health Organization and UNAIDS estimated that reaching that target number of men could reduce new HIV infections by 20 percent in ten years, and save $16.6 billion in medical costs.
"We need to refocus on this inexpensive, one-time intervention that offers men life-long partial protection against HIV," said Mitchell Warren, executive director of AVAC, at this year's IAC in Washington, D.C.
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