December 14, 2006 in Nation/World

Circumcision may deter HIV

Craig Timberg Washington Post

at a glance

Traditional tribal ritual

Most African tribes historically performed ritual circumcisions as adolescent boys became men, but the practice has been declining as the continent has Westernized and traditional practices have been abandoned. Studies have long shown that areas with the highest HIV rates – South Africa, Botswana, Swaziland, Zimbabwe and others – have low circumcision rates. And in West Africa, where circumcision remains common, HIV rates are far lower.

JOHANNESBURG, South Africa – Two major studies released Wednesday confirmed that circumcision can dramatically slow the spread of HIV among African men, suggesting that widely offering the procedure could prevent millions of deaths in countries most seriously affected by AIDS, researchers said.

The studies, in Kenya and Uganda, found that circumcised men are about 50 percent less likely to contract HIV than those who are not, a result that echoed similar research last year from South Africa.

In all three studies, the results were so persuasive that researchers stopped their experiments several months early and offered circumcisions to all of the subjects, deeming it unethical to withhold a procedure that might prevent an often-fatal disease.

The results appeared to dispel lingering doubt that circumcision protects men from AIDS. But it only sharpened questions about whether it is possible to offer the procedure widely enough to slow an epidemic that kills millions of people each year, mostly poor Africans with scant access to safe, modern medical facilities.

“People are dying,” said Bertran Auvert, a French researcher who led last year’s study in South Africa. “We must do it. It’s an ethical obligation. I’m not saying we need to circumcise people, but we must be making it accessible, affordable and widely available.”

Circumcision, which removes the foreskin from a man’s penis, eliminates the cells most vulnerable to HIV infection, researchers say. A circumcised penis also develops thicker skin that’s resistant to infection. A separate study under way in Uganda is attempting to determine whether, as some researchers believe, a circumcised man also is less likely to transmit the virus to his sexual partners.

Male circumcision is common at birth in the United States. But the procedure remains controversial among some critics who say it diminishes sexual sensation while providing no meaningful medical benefits.

Researchers announcing Wednesday’s results in a conference call from the National Institutes of Health in Bethesda, Md., cautioned that circumcision should be used only as part of a broad prevention strategy, and they emphasized that its effect is limited.

In each study, thousands of men were recruited, and half were circumcised. Both groups were counseled, urged to use condoms and routinely tested for HIV. The study found no significant difference in the sexual behavior between the two groups, yet they contracted HIV at sharply different rates.

In Rakai, Uganda, among 4,996 men, 22 of those who were circumcised and 43 of those who weren’t contracted HIV, a difference of 48 percent. In Kisumu, Kenya, among 2,784 men, 22 of those who were circumcised and 47 of those who weren’t contracted HIV, for a difference of 53 percent.

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