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13 February 2006
Foreskin Appears To Harbor HIV
by George Atkinson

A continuing investigation into the relationship between circumcision and HIV infection in Africa has uncovered further insights into the apparently beneficial effects of circumcision on HIV infection rates. The findings were presented as part of a plenary discussion at the 2006 Conference on Retroviruses and Opportunistic Infections, in Denver, Colorado.

Past studies have alluded to the prophylactic effects of circumcision, and a recent study had to be halted as the researchers involved thought it unethical to continue given the compelling findings. The new study was based on a statistical review of the medical files of more than 300 couples in Uganda, in which the female partner was HIV negative and the male was HIV positive.

The researchers said the results provided firm documentation of the protective effects of male circumcision in reducing the risk of HIV infection among women. It also appears that circumcision reduced rates of trichomonas and bacterial vaginosis in female partners. The researchers claim it is the first study to demonstrate the benefits to female partners of male circumcision.

The results showed that circumcision reduced by 30 percent the likelihood that the female partner would become infected with HIV. Similar reductions in risk were observed for trichomonas and bacterial vaginosis, but not for other common STDs, such as human papillomavirus, syphilis, gonorrhea and Chlamydia.

Circumcision's effects are believed to come from the nature of the foreskin's inner lining, or mucosa, whose cells bind to the virus more easily and have roughly nine times more virus in them than the outer layer of the foreskin. Removal of the foreskin, say the researchers, may simply reduce the susceptibility factor, or degree of exposure to HIV, for the sexual partner.

Circumcision is a divisive issue and the researchers are understandably guarded when discussing the possibility of circumcision on a massive scale. "We will have to wait for the ongoing two trials before drawing conclusive recommendations about circumcision for all men, and whether or not the benefits apply to transmission from females to males only, or to females from men as well. However, early indications are dramatic and, if proven, one case of HIV disease could be prevented through circumcising anywhere from 15 to 60 males," said Thomas C. Quinn, professor of infectious diseases at John Hopkins and a senior investigator at the National Institute of Allergy and Infectious Disease.

Based on material from Johns Hopkins

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