No clear evidence yet that circumcision reduces HIV risk

Circumcised men may be less vulnerable to HIV, but there is not yet enough clinical evidence to merit the wide promotion of circumcision as an anti-HIV measure, said AIDS prevention expert Quarraisha Abdool Karim, associate professor of public health at the Nelson Mandela School of Medicine in South Africa. On July 15 at the 15th International AIDS Conference in Bangkok, Thailand, Karim said three major ongoing studies could answer the question in a few years. "Results from these trials will need to be carefully considered prior to any public health policy decision," she said. Researchers have long thought that male circumcision may help protect men from HIV and prevent them from spreading it since the foreskin's Langerhans cells have receptors that could facilitate viral entry. Bodily fluids that can contain HIV also can be trapped beneath the foreskin in uncircumcised males and placed into direct contact with the vulnerable cells. A protective benefit has been reported in several observational studies, including one in Uganda that examined couples in which one partner had HIV. In the study's circumcised men, researchers found zero HIV infection compared to 16.7% in those not circumcised. However, Karim noted that the studies conducted to date contained several important biases that could distort the results, including varying sexual behavior. The three large-scale trials, which began at the end of 2002 or early 2003, involve thousands of both circumcised and uncircumcised men in Kenya, Uganda, and South Africa. The studies are due to run for three to four years.