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18 December 2006
Another HIV Circumcision Trial Halted
by George Atkinson

Much like an earlier joint European and African trial last year, a US led study into whether circumcision can reduce HIV infection has been halted due to ethical concerns. Preliminary results from the University of Illinois at Chicago study indicated that medical circumcision reduces the risk of acquiring HIV during heterosexual intercourse by an astonishing 53 percent.

The robustness of the results prompted the study's Safety and Monitoring Committee to recommend the trial be halted and that all men enrolled in the study who were uncircumcised be offered circumcision. The study's principal investigator, Robert Bailey, was unequivocal in his reading of the results. "Circumcision is now a proven, effective prevention strategy to reduce HIV infections in men," he said.

The trial involved 2,784 HIV negative men from Kenya between 18 and 24 years old. Half the men were randomly assigned to circumcision and half remained uncircumcised. The results showed that 22 of the 1,393 circumcised men in the study contracted HIV, compared to 47 of the 1,391 uncircumcised men. Put another way, circumcised men had 53 percent fewer HIV infections than uncircumcised men.

Circumcision's apparent preventative effect has been a source of controversy, and until now, public health organizations have not supported circumcision as a method of HIV prevention due to a lack of randomized controlled trials. But that should now change, says Bailey. "With these findings, the evidence is now available for donor and normative agencies, like WHO and UNAIDS, to actively promote circumcision," he said, adding that it was important that circumcision be backed up with other interventions.

"Circumcision cannot be stand-alone. It has to be integrated with all the other things that we do to prevent new HIV infections, such as treating sexual transmitted diseases and providing condoms and behavioral counseling," Bailey explained. "We can't expect to just cut off a foreskin and have the guy go on his merry way without additional tools to fight against getting infected."

While opponents of circumcision worry that circumcised men may feel they are not at risk of contracting HIV and may therefore be more likely to engage in risky behavior, Bailey says that he Kenya study suggests that circumcision did not increase risky behavior among circumcised or uncircumcised men. "Both uncircumcised and circumcised men are reducing their sexual risk behavior," he said, "which indicates that our counseling is doing some good."

But Bailey expressed concern about the growing demand for circumcision among African men driving a rise in potentially dangerous backyard procedures. "Already, there are large numbers of boys and young men who are seeking circumcision in areas of Africa where men are not traditionally circumcised," he said. "The danger is that unqualified practitioners will fill a niche by providing circumcision, but with much higher complication rates."

Based on material from the University of Illinois at Chicago

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