TORONTO – A practice dating back to biblical times could soon join the list of powerful weapons against AIDS.
New studies suggest that male circumcision -- the surgical removal of the foreskin from the penis -- could avert hundreds of thousands of new HIV infections and save millions of dollars.
The research, presented at the International AIDS Conference here, builds on last year’s finding that circumcised heterosexual men are at least 60 percent less likely to contract HIV than their uncircumcised counterparts.
Kevin De Cock, MD, director of the World Health Organization’s HIV/AIDS program, says that if the findings hold up, the global agency will issue guidelines backing the procedure for HIV prevention.
Male circumcision could avert as many as two million new infections over 10 years in sub-Saharan Africa alone, he tells WebMD.
De Cock says his agency will await the results of two more large studies, expected to be completed next year in Kenya and Uganda, before making a move.
Circumcision Cuts Costs
In the meantime, early results from another, ongoing study of tea plantation residents in rural Kenya support last year’s findings.
That study, presented here this week, showed circumcised men were about two-thirds less likely to contract HIV over a two-year period than uncircumcised men.
In yet another study, YaleUniversity researchers projected that increasing circumcision rates by just 10 percent to 20 percent could ward off 32,000 to 52,000 infections in Soweto, South Africa alone over the next 20 years.
Other new research suggests circumcision would be cost-effective.
And, despite worries that circumcised men would feel safe and engage in risky behaviors, University of Illinois researchers found that half of recently circumcised men reported using condoms more consistently and paying for sex less frequently.
Obstacles to Overcome
No one’s really sure how circumcision might prevent infection with HIV, but De Cock offers several possibilities.
The foreskin is covered with a much thinner layer of cells than the penis, which could facilitate invasion by the virus, he says. Also, the foreskin has more cells that have targets for the virus, De Cock says.
Even if the procedure does pan out in the current trials, there are obstacles to overcome, researchers warn.
First is a shortage of health care workers trained to perform the procedure in developing nations, says French researcher Bertran Auvert, MD, who led last year’s study. “We need to develop a method that is simple, fast, safe, of low cost, and usable by nurses,” he says.
Cultural taboos also have to be dealt with, says Catherine Hankins, MD, chief scientific officer for the United Nations' UNAIDS program.
“Circumcision has deep cultural significance in many cultures,” she tells WebMD. “It’s tied into the significance of what it means to be a man.”
Hankins stresses that circumcision is not a magic bullet.
“It is possible that whatever gains might be made through male circumcision could be wiped out by people letting down their guard,” she says. “A circumcised man might think he no longer needs to use condoms. A woman might think, ‘He's circumcised, I don't need to raise the issues of condoms.'
“We need to get the word out that circumcision is just one element of a comprehensive HIV prevention package,” Hankins says.
By Charlene Laino, reviewed by Louise Chang, MD
SOURCES: XVI International AIDS Conference, Toronto, Canada, Aug. 13-18, 2006. Kevin De Cock, MD, director of the World Health Organization’s HIV/AIDS program. Bertran Auvert, professor of public health, University of Versailles, France. Catherine Hankins, MD, chief scientific officer for the United Nations' UNAIDS program.