A surgical strike against AIDS
The ABCs of AIDS prevention -- Abstinence, Being faithful to your partner, and using Condoms -- now have a second C: Circumcision for males. In two studies in Africa by the National Institutes of Health, this procedure proved so beneficial in stopping transmission of HIV that officials have said continuing the experiment would be unethical. Officials of both the Global Fund to Fight AIDS, Tuberculosis, and Malaria and President Bush's $15 billion AIDS program see the results as an endorsement of this prevention method. Both the global fund and the US program should make circumcision a central strategy as soon as possible.
The explanation for the protective effect of this procedure is that the underside of the foreskin in uncircumcised men has many immune system cells that are particularly vulnerable to the AIDS virus. Researchers in Africa have for years observed that members of Muslim communities that practice circumcision have lower rates of HIV infection than men from communities where it is not common. It was not clear, however, that it was circumcision and not differing religious and social customs that provided the protection.
The NIH studies removed any doubt. Thousands of uninfected heterosexual men in Kenya and Uganda were divided into two groups, one that would be circumcised and one that would not. While both groups received training in safe sex practices, the training did not stop members of both groups from becoming HIV-positive. But the circumcised men in Kenya were 53 percent less likely to become infected; in Uganda, they were 48 percent less likely. The results echo those of a study done with French financing in South Africa last year. An additional study of medical records in Uganda last year found that infected men who were circumcised were 30 percent less likely to transmit the virus to their female partners than uncircumcised infected men.
As circumcisions become a standard means of AIDS prevention, officials say there will have to be several caveats. One is that the procedure must be done with sterile equipment; contaminated cutting instruments could actually accelerate the transmission of AIDS or other blood-borne diseases. Also, the circumcised men must be advised in strong terms to continue to practice safe sex, because the protection afforded by the procedure is only partial.
Still, even partial protection will represent substantial progress. For years, AIDS researchers have struggled to produce a vaccine, and would be content with one that provided a 50 or 60 percent reduction in infections. A procedure such as circumcision, which could be administered by trained non-physicians for relatively low cost and provide close to that level of protection, would save millions of lives.
