Ouch! It?s going to hurt, but it now looks beyond doubt that male circumcision can help reduce the spread of AIDS in Africa. New results unveiled yesterday from trials in Kenya and Uganda show that circumcised men lower their risk of HIV infection by about half.As we reported in November
, governments in Sub-Saharan countries where AIDS is rife were already considering circumcision as a possible way to stop the spread of HIV. The latest findings will strengthen their case for taking steps to make safe circumcision more widely available.
In both trials, heterosexual men free of HIV infection were randomly assigned either to be circumcised or not, then monitored to see if they subsequently picked up HIV through sex. In Kisumu, Kenya, a trial of 2784 men showed that circumcised men were 53% less likely than uncircumcised men to pick up the virus. Likewise, in a trial of 4996 men in Rakai, Uganda, the risk of infection was 48% lower in circumcised men.
The trials were halted on 13 December on ethical grounds by the US National Institutes of Health
, which funded them, so that uncircumcised men in the trial can receive the treatment too. They also echo the results of an earlier trial in Orange Farm, a suburb of Johannesburg in South Africa, which showed that circumcision cut infection by 60%.
The World Health Organization
and UNAIDS are meeting in late January 2007 to analyse the results in detail and to assess the policy options for countries considering making circumcision more widely available.
But a few big, big notes of caution: Before African men line up to have part of their penis chopped off, it?s important for them to realise it doesn?t make them immune from infection. Nor does it free them from having to follow all the usual safe-sex behaviour, such as having fewer sexual partners and wearing condoms. There are also surgical risks from the procedure in countries where it?s mostly done at present by untrained individuals.
Nor does male circumcision provide much respite for women, who suffer the bulk of the HIV burden in Africa. And it doesn?t work for homosexual men, because circumcision doesn?t protect the passive partner in anal sex. So overall, fantastic results, but don?t forget all the other vital measures to prevent HIV spreading.