Impact of male circumcision on the female-to-male transmission of HIV

[Tyfon]

For those who have heard via the media of this study, presented at the International AIDS Society Conference in Rio this week, and want the info. 'from the horses mouth', here is the original abstract for the presentation (from:http://www.ias-2005.org/planner/Abst...aspx?AID=2675).

Impact of male circumcision on the female-to-male transmission of HIV
Auvert B.1, Puren A.2, Taljaard D.3, Lagarde E.4, Sitta R.4, Tambekou J.4

1UVSQ - INSERM U687 - APHP, ST Maurice CEDEX, France, 2NICD, Johannesburg, South Africa, 3Progressus CC, Johannesburg, South Africa, 4INSERM U687, St Maurice, France

Introduction: Observational studies suggest that male circumcision could protect against HIV-1 acquisition. A randomized control intervention trial to test this hypothesis was performed in sub-Saharan Africa with a high prevalence of HIV and where the mode of transmission is through sexual contact.

Methods: 3273 uncircumcised men, aged 18-24 and wishing to be circumcised, were randomized in a control and intervention group. Men were followed for 21 months with an inclusion visit and follow-up visits at month 3, 12 and 21. Male circumcision was offered to the intervention group just after randomization and to the control group at the end of 21 month follow-up visit. Male circumcisions were performed by medical doctors. At each visit, sexual behavior was assessed by a questionnaire and a blood sample was taken for HIV serology. These grouped censored data were analyzed in an “intention to prevent” univariate and multivariate analysis using the piecewise survival model, and relative risk (RR) of HIV infection with 95% confidence interval (95% CI) was determined.

Results: Loss to follow-up was <11%; <1% of the intervention group were not circumcised and < 2% of the control group were circumcised during the follow-up. We observed 45 HIV infections in the control group and 15 in the intervention group, RR=2.77 (95% CI: 1.56 – 4.91; p=0.0005). When controlling for sexual behavior, including condom use and health seeking behavior, the RR was unchanged: RR=2.93 (p=0.0003).

Conclusions: Male circumcision provides a high degree of protection against HIV infection acquisition. Male circumcision is equivalent to a vaccine with a 63% efficacy. The promotion of male circumcision in uncircumcised males will reduce HIV incidence among men and indirectly will protect females and children from HIV infection. Male circumcision must be recognized as an important means to fight the spread of HIV infection and the international community must mobilize to promote it.

Ken's Analysis:
This abstract actually goes further than some of the media reports suggest, with its comparison of circumcision with a 'vaccine of 63% efficacy' and 'the international community must mobilize to promote [circumcision]'. It should, at this stage, not be interpreted that circumcised males are 'safer' having unprotected sex than their uncircumcised counterparts, but rather that uncircumcised males should be especially mindful of safe sex practices. Circumcised males should bear in mind that the 'protection' afforded by circumcision, according to this study, only reduces risk by 63% - unprotected sex is still playing Russian Roulette: you're just using a nine- or ten-chamber pistol instead of a six-chamber.

Cheers,

K.

[tintin]

MMm, but with a very occasional blunder your risk are nevertheless lower then it would have been normally.

Ok, I am not mad at my mummy anymore to have altered my "zi-zi"!

[cotambear]

After circumcision, the now more exposed penis glans is roughened by its contact with fabric. A layer of protective tissue builds up, and it is this that acts as a barrier to the virus. However, its not 100% protection, so always rubber up.

[tintin]

Originally Posted by cotambear

After circumcision, the now more exposed penis glans is roughened by its contact with fabric. A layer of protective tissue builds up, and it is this that acts as a barrier to the virus. However, its not 100% protection, so always rubber up.

That is for sure! But if you get a condom that breaks, you still will have a bit more protection!

[swiftdave]

If the unit is cut completely 100% protection can be assured. Just seems a little drastic!