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How Well Does Circumcision Slow the Spread of HIV / AIDS?

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The war against infectious disease often requires multiple weapons. Chlorinated water, sewage treatment plants, and surface disinfectants for hospital use contribute to the control of bacterial disease. These sanitation measures are probably much more important than antibiotics in terms of the number of people who die of infection.

Viral diseases present their own challenges. The smallpox virus was eradicated by a worldwide vaccination program, but many other viruses mutate too fast for this approach. Flu shots, for example, have to be repeated every year because new strains of influenza virus emerge. The HIV virus that causes AIDS is even worse: it rapidly develops resistance to anti-viral drugs, and it has escaped efforts to develop a vaccine for almost 30 years.

Male circumcision is one tool to slow the spread of HIV. According to a recent review in the medical literature, this procedure reduces the risk of female-to-male transmission of the virus by 60 percent. It does not appear to change the risk of male-to-male transmission, so the mechanism is not clear. But it does work, to some extent, and is believed to provide life-long partial protection.

So is it a good idea to circumcise all men? A team of researchers from the Joint United Nations Programme on HIV/ AIDS (UNAIDS), the World Health Organization (WHO), and the South African Centre for Epidemiological Modelling and Analysis (SACEMA) presented results from mathematical modeling studies. There are two major cautions:
1. Risk compensation: if circumcised men think they are safe from AIDS, they may engage in more risky behavior. The studies reported so far do not indicate this as a problem among men who receive intensive health education along with circumcision.
2. Cost: Circumcision programs may take funds away from other health programs, such as education and condom distribution. Thus the authors recommend starting with areas of high HIV prevalence, and with men at high risk. This generally includes the age group 15 to 34 years old. Circumcising babies is lower cost and provides long-term population benefits, but it may not be the most cost-effective solution if a vaccine is developed within the next 20 years.

The models cited all show that male circumcision is not enough to stop the HIV epidemic, but it can make a difference. For areas with low rates of male circumcision and high rates of HIV infection, the prediction is that one HIV infection can be prevented for every five to 15 circumcision procedures.


UNAIDS/WHO/SACEMA Expert Group, “Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making?”, PLoS Medicine 2009 September; 6(9): e1000109. Epub 2009 Sep 8.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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November 14, 2011 - 5:06am
EmpowHER Guest

There are many other factors, such as the HIV status of partners, number of partners, frequency of sexual activity, use of condoms, and more, that the researchers assume were equalised by randomisatation and unaffected by circumcision, when they probably were not. The trials were not, of course, double blinded or placebo controlled, the true gold standard of medical trials.phillies tickets

September 22, 2011 - 5:17am
EmpowHER Guest

Circumcision is genital mutilation no matter if it is a boy or girl. America had a 90% circumcision rate in the 70's and still had very high HIV rates. Europe does not circumcise and have some of the lowest HIV rates in the world. Proper education, safe sex, and condoms is what can present HIV. Circumcision does not have a role in this.

June 15, 2010 - 6:54pm

How well does circumcision protect against HIV? Here is the sum total so far.

In the three trials, they circumcised a total of 5,400 men and left simlar groups alone. After less than two years, 64 of the first groups had HIV, and 137 of the second. That difference, 73 men, is the whole of the protection that has actually been demonstrated. All of the "modelling" (basically just multiplying those numbers by population and time) stands or falls on them. The overall Number Needed to Treat for the three trials was 39, so how did they beat it down to 5 or 15?

There are many other factors, such as the HIV status of partners, number of partners, frequency of sexual activity, use of condoms, and more, that the researchers assume were equalised by randomisatation and unaffected by circumcision, when they probably were not. The trials were not, of course, double blinded or placebo controlled, the true gold standard of medical trials. 673 men (327 circumcised) were lost from study, their HIV status unknown, and a difference of 73 could easily be hidden in those figures. (Finding you had HIV, after a painful and marking operation to prevent it, would be a powerful incentive to drop out, and they were not told their HIV status but encouraged to be tested nearby.)

Behind all this is the mystery of why circumcision has such a hold on the popular imagination; why it has been a "cure" in search of a disease for so long, why it has never been subjected to the same scrutiny as any other parental imposition or surgical procedure, and why cutting part OFF a man's (or baby's) penis is somehow seen as enhancing his manhood.

June 11, 2010 - 5:15pm
EmpowHER Guest

reduces the risk of female-to-male transmission of the virus by 60 percent."
Well that has not been observed in populations in the industrialized world. In other words, this risk reduction has really only been observed by circumcision pushers that did the study. the observed reduction was ALWAYS less than 60% and of course the actual risk change was in the range of about 1.4% risk change -- again not observed in large population studies. So it is outrageous to say that this is in any way useful for the industrialized world.

The same researchers stopped the male to female circumcision study because it showed circumcised men pass HIV to women at a higher rate than natural men. So this article is misleading and propaganda on many levels. This is similar and no more useful than the studies that show female circumcision lowers the risk of male-to-female transmission of the virus by about 60 percent.

Circumcision is nerve damage cutting off about 20000 fine touch and stretch sensing nerve endings and removing a source of pleasure from the male FOR LIFE. This is 2/3 of the total pleasure source amputated! This is nerves, blood vessels, protective covering and pleasure zones taken away from a human before the human can experience this. The dynamics and function and pleasure from sex and masturbation of the penis is harmed for good. This is a horrible thing for any medical professional to push.
Push condom use. A condom is not great, but it feels so much better when you have all of your natural penis.

June 11, 2010 - 6:28am

Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

June 10, 2010 - 4:50pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.


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