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27 October 2005
Experts Say Circumcision Should Be Promoted As Part Of AIDS Prevention
by George Atkinson

Earlier studies that showed male circumcision reduced the rate of HIV infection relied on data collected from surveys, but a new study - that also found circumcision to be beneficial - took a much more direct method to deliver its results.

Researchers have known for some time that HIV infection rates are lower among African groups where circumcision is a traditional practice. It was suspected that circumcision might offer some protection against HIV transmission but experts also acknowledged that the reduced infection rate could also be due to some other difference between circumcised and uncircumcised populations. So the researchers, from France and South Africa, decided that the only way to test whether circumcision had a protective effect was to carry out a randomized intervention study.

This involved offering young sexually active uncircumcised heterosexual men the chance to be circumcised and then monitored for HIV infection. More than 3,000 participants were randomly allocated into two groups - one group was immediately circumcised and the other group was to remain uncircumcised until after the completion of the trial. The circumcised men were instructed to abstain from sexual activity for 6 weeks after the operation. The participants were monitored over 21 months and tested for HIV at months 3, 12 and 21, to see whether there was a difference in the rate of new infections between the two groups. The results, which showed that the circumcised males were 60 percent less likely to become infected, were reported in the journal PLoS Medicine. The study does not identify the mechanism by which circumcision confers the added proetection.

The results were so significant that the trial was halted. The committee monitoring the study considered that the protective effect of male circumcision was so large that it would be unethical to continue the study. Consequently, the trial was stopped and the uncircumcised men were offered circumcision.

The authors of the study have called for the promotion of male circumcision as part of AIDS prevention efforts in Africa. But other HIV experts are more cautious, saying that the results of this one study must be confirmed by further studies before any action can be recommended. And it seems the United Nations agrees. UNAIDS emphasized that "although the trial shows promising protective effects of adult male circumcision in HIV acquisition, more research is needed to confirm the reproducibility of the findings and of this trial and whether or not the results have more general application."

Other concerns relate to how the circumcision is carried out, particularly if the procedure is performed by tribal healers rather than medical personnel. And it may be that newly circumcised men, considering themselves to be "protected," might be more likely to engage in unsafe sex.

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