Circumcision prevents three out of four female-to-male HIV infections

Discussion in 'The euphoric body' started by Lunar Loops, Dec 15, 2006.

  1. Lunar Loops

    Lunar Loops Driftwood Platinum Member & Advisor

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    OK, I know this study is a little old, but I had not seen it before (does anyone know if there is any newer information available?).

    I feel that their claim is a little extravagant to say the least. More information would be required on the test subjects and their sexual activity during the trial period (not to mention, whether or not they heeded the safe sex advice they had been given). Quite apart from all of that I don't see how this would work. Maybe my mind is being particularly slow today, but I can see how it would promote personal hygene and reduce yeast based infections (like our good friend the songbird), but how would it prevent transmission of the HIV virus? Anyone care to enlighten me?

    Anyway, this from Aidsmap.com (http://www.aidsmap.com/en/news/BA448CC3-7935-43E6-947C-987D69B82D54.asp) :

    IAS: Circumcision prevents three out of four female-to-male HIV infections

    The first ever randomized controlled trial (RCT) of male circumcision as an HIV prevention measure has produced such strong evidence of a protective effect that the trial has been halted early and all participants have been offered circumcision, the Third International IAS Conference on HIV Pathogenesis and Treatment in Rio de Janeiro heard on July 26th.

    There were only 35% as many infections in the circumcision arm as opposed to the control arm, implying that circumcision can prevent at least six out of ten female-to-male HIV transmissions.

    However, when the results were analysed according to true circumcision status rather than by intervention group, the protective effect went up to 75%. This is because there were ‘crossovers’ between the intervention and control arms in that some men randomized to be circumcised were not, and some in the control arm were.

    The trial, the first of four RCTs of circumcision being conducted in Africa, randomised 3,273 men aged 16 to 24 to be circumcised at the start of the trial or to be offered circumcision at the end of it 21 months later.

    The men lived in the Orange Farm township near Johannesburg, South Africa. A previous acceptability study had found that 70% of the local male population said they were willing to be circumcised if it could prevent HIV, and in fact 20% already are, with a surprisingly late median age of circumcision of 17.

    The HIV prevalence in the area is high, at 31.6% of the adult population. In the trial population 90% of men were sexually active by the start of the study, with a mean age of sexual debut of 16.6.

    Circumcisions in the intervention arm were carried out by a surgeon under local anaesthesia and with post-operative pain relief given.

    Presenter Bertran Auvert of the French HIV Research Institute INSERM stressed the safety of the procedure and said that there had been no deaths or permanent adverse effects in any participant. Thirty-one per cent complained of pain and 15% initially had problems with the changed appearance of their penis.

    HIV incidence was measured at three and twelve months into the trial and finally at 21 months though the average follow-up period was in fact 20 months due to the premature termination of the trial.

    Although all participants received intensive safer sex counselling and condoms, there were 51 HIV seroconversions in the control arm versus 18 in the circumcision arm. This translates as HIV incidences of 2.2% and 0.77% a year respectively.

    In the control arm there were nine, 15 and 27 new infections at three, 12 and 21 months and in the circumcision arm two, seven and nine.

    "This is the first RCT demonstrating a strong protective effect of safe male circumcision", said Auvert.

    He added that as a short term study it could not predict the long term effect of circumcision, but that its compelling results now demanded discussions on the use of circumcision as a public health measure.

    Circumcision may also substantially cut the male to female transmission rate, the conference heard. Ronald Gray, one of the investigators behind the long-standing Rakai prevention cohort in Uganda, said that studies at Rakai and other centres had indicated that HIV-negative women with circumcised HIV-positive partners had only 0.41 as many seroconversions as partners of uncircumcised men.

    Reference

    Auvert B et al. Impact of male circumcision on the female-to-male transmission of HIV. IAS Conference on HIV Pathogenesis and treatment, Rio de Janeiro, abstract TuOa0402, 2005
     
  2. Jatelka

    Jatelka Psychedelic Shepherdess Platinum Member & Advisor

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    There is a particularly high concentration of Langerhans cells in the skin of the foreskin. These are "antigen presenting cells" which deal with viruses and "present" them to the immune system. Of course with HIV you really don't want it to be presented to the immune system. The fewer Langerhans cells (ie: Lack of foreskin) reduces the chance that HIV will gain entry by this route.

    (see here for more details...

    http://www.bmj.com/cgi/reprint/320/7249/1592.pdf)
     
  3. Nature Boy

    Nature Boy Gold Member

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    I would be very skeptical of this kind of study. It has become known in recent years that circumcision, believe it or not, has become big business. Every circumcision proceedure costs in excess of $500 and many research companies use the disposed foreskins and might even pay big bucks for a bunch of them. The above study may well have been spun together in order to take pressure off the increasing idea that infant circumcision is a form of cruelty, a breach of human rights even, much like the way the tobacco lobby secretly fund many anti-marijuana studies in order to keep its illegal state preserved as a means of protecting the sales of their product.
     
  4. zera

    zera Gold Member

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    There are a couple reasons to be skeptical, first they stopped the study early because they thought the benefits were so great that they circumcised the control group.

    But more importantly the situation in Africa isn't really translatable to the first world. Female to male transmission of HIV is the the second lowest risk transmission, with male to female transmission being twice as likely (ie a female has double the chance of catching it from a HIV+ male than vice versa), and male to male (and male to female anal) transmission being much much higher. Intravenous transmission is the highest risk (don't share needles!). Female to female transmission (and any oral transmission) the lowest risk by far, in fact it's even questionable if this is possible.

    Anyway the reason that HIV basically doesn't infect heterosexual, non intravenous drug using, but spreads among these populations in the third world is because of the high prevalence of other STDs. Penis to vagina fluid transmission is a very low risk, but when you start getting open sores in the genital area transmission risk spikes. Because there are tons of Africans with perfectly treatable STDs (that would take nothing more than $50 and a trip to the clinic in the first world) HIV has spread among a population (heterosexual, non intravenous drug users) in Africa that it barely touches in Europe and America.

    Instead of mutilating genitalia for a less than an order of magnitude drop, we should instead make antibiotics widely available across the continent (antibiotics are cheap as hell), and there'd be a huge drop in transmission rates. For the same amount we spend on anti-viral drugs to treat current AIDS victims, we could spend it on antibiotics to treat these other STDs and save 100 times as many people.
    http://www.forbes.com/business/forbes/2005/0725/044.html
     
  5. Lunar Loops

    Lunar Loops Driftwood Platinum Member & Advisor

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    Many thanks for the informative answer and the link.
     
  6. Jatelka

    Jatelka Psychedelic Shepherdess Platinum Member & Advisor

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    Attached is some more info. Not in archive coz SWIJ couldn't work out where it would go (and only relating to this thread really!)
     

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