Male circumcision reduces
HIV risk: No further evidence needed
Wednesday, April 15,
2009
Three recent African trials
support male circumcision for reducing the risk of contracting HIV
in heterosexual men. After including new data from these trials in
their review, Cochrane Researchers have changed their previous
conclusions that there was insufficient evidence to recommend
circumcision as an intervention to prevent HIV infection in
heterosexual men.
"Research on the effectiveness of male circumcision for preventing
HIV in heterosexual men is conclusive. No further trials are
required to establish that HIV infection rates are reduced in
heterosexual men for at least the first two years after
circumcision," says lead researcher Nandi Siegfried, Co-director of
the South African Cochrane Centre at the South African Medical
Research Council. "Policy makers can consider implementing
circumcision as an additional measure into HIV prevention
programmes."
Circumcision may help to protect against HIV by removing cells in
the foreskin to which the virus is specifically attracted. Called
Langerhans cells, they display receptors that enable HIV entry.
Previous non-randomised studies investigated the association
between circumcision and HIV, but until now, Cochrane researchers
have been unable to make strong recommendations for the
intervention due to a lack of high quality evidence gained from
randomised clinical trials.
The clinical trials included in the review took place in South
Africa, Uganda, and Kenya between 2002 and 2006, and included a
total of 11,054 men. The results show that circumcision in
heterosexual men significantly reduces their risk of acquiring HIV
by 54% over a two year period, compared with uncircumcised men.
This reduced risk is the best estimate of the average effect and
the researchers report that the true risk will be reduced by
between 38 to 66%. Further research, however, is required to
establish whether male circumcision offers any benefit to women
partners of circumcised men and homosexual men.
The researchers warn that policy makers also need to think about
the culture and environment in which circumcision is carried out.
"In many countries, male circumcision is practiced as part of the
rites of initiation by traditional healers who are not trained in
aseptic surgical techniques. So adverse events following
traditional circumcisions can be high," says Siegfried.
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Wiley-Blackwell
Thanks to Wiley-Blackwell for this
article.