Intoxicatingmoon
2004-11-27 13:45:35 UTC
This Boston Globe article is worth a read:
==========================================
Circumcised men less likely to get AIDS
By John Donnelly, Globe Staff | November 16, 2004
JOHANNESBURG -- Men who are circumcised have a dramatically lower rate
of HIV infection than those who are not, according to new studies in
Africa and India, suggesting that the ancient surgical procedure may
play a role in helping prevent the spread of the deadly virus.
One unpublished household survey in Kenya has shown that uncircumcised
men have an HIV rate that is 11 times greater, while a second study in
India has found uncircumcised men have a seven times higher rate of
infection. Other studies showed that Zambia and Ethiopia had lower
rates of HIV infection in areas of the countries where circumcision
was more common. Researchers have suspected a link between
circumcision and HIV prevention for more than 15 years. In the United
States, studies have shown that high circumcision rates have had a
protective benefit for heterosexual Americans. But most specialists
have not recommended the procedure because they believed that other
factors such as religious and cultural beliefs might explain the link.
The recent Kenya data, however, have given new impetus among some AIDS
experts to focus more attention on the issue. The Kenya study was
completed by the Demographic and Health Surveys, a Maryland-based
independent group that conducts detailed surveys around the world.
Leaders in at least two African countries, Swaziland and Zambia, have
said that, while they want more definitive evidence linking
circumcision with preventing HIV, they say the epidemiological studies
have startled them.
"Watch this. There could be some breakthroughs coming out of this,"
Derek von Wissell, director of Swaziland's National Emergency Response
Council on HIV/AIDS, said in a telephone interview from Mbabane, the
capital. "If the evidence comes through, we could really look at this
as a preventive measure. It's almost as effective as a vaccine. The
effect would be massive."
World Health Organization officials, however, warn that ongoing
clinical trials need to be completed before deciding whether
circumcision should be recommended as a prevention tool against the
spread of HIV. Those studies, underway in Kenya, Uganda, and South
Africa, will be completed in one to three years.
"The numbers are striking, but we have to make sure that's really the
effect from circumcision," said Kevin R. O'Reilly, a WHO specialist on
the treatment and prevention of HIV and AIDS. "We don't know if the
elevenfold increase we're seeing in Kenya is related to circumcision
alone or differences in sex patterns, religious patterns, and other
things."
O'Reilly said that even if male circumcision was shown to help prevent
HIV, "the question is, what do you do with that information? . . . The
preference for or against circumcision among different groups is a
fairly strongly-held conviction. It has a lot to do with group
identify. In tribal circumstances, it might be us vs. them -- we
circumcise and they don't."
He also expressed concern that some men who believe circumcision
prevents HIV might abandon other safe-sex precautions. "We have a long
history in HIV/AIDS prevention learning time. . . . There is no magic
bullet."
Circumcision, the removal of the foreskin of the penis, is one of the
world's oldest and most common surgical procedures. It is part of a
ritual practiced for thousands of years by Jews and Muslims. Many
Christians and people of other faiths also are circumcised, and the
procedure is most often performed on newborn babies boys in the USA.
According to a review of scientific research by the US Agency for
International Development, the inner surface of the foreskin absorbs
HIV up to nine times more efficiently than female cervical tissue.
Circumcision is already known to reduce a man's risk of penile cancer.
A study of 393 men from a clinic in Tuscon, published last month in
the journal Sexually Transmitted Diseases, also found that
circumcision may reduce the risk of cervical cancer in female sexual
partners. That confirmed an earlier five-country study published in
the New England Journal of Medicine.
In Africa, the countries with the highest rates of HIV infection are
in the far south, which have low circumcision rates. Countries in West
Africa and the island nation of Madagascar have lower HIV prevalence
and very high male circumcision rates.
For years, most AIDS experts have said that the lower rates were
largely attributable to large Muslim populations, which generally had
more conservative sexual behaviors than Christian communities.
Conservative religious beliefs and sexual behavior apparently do not
explain some situations for low HIV prevalence. In Madagascar, where
nearly 100 percent of boys are circumcised by puberty, about 10
percent of the population is Muslim, 45 percent Christian, and 45
percent follow traditional beliefs. The island also has high rates of
sexually transmitted infections, which can increase risk for HIV
transmission. And yet the island's HIV prevalence is estimated at 1.4
percent.
"It's an intriguing question why HIV prevalence varies so dramatically
across different parts of Africa as well as parts of Asia," Daniel
Halperin, a USAID expert on HIV prevention, said in an interview from
Washington. "The main, although not the only, factor explaining this
appears to be male circumcision."
But Halperin, who has been one of the most passionate supporters for
more research on male circumcision and health, said that USAID would
not recommend mass circumcision campaigns to lower HIV risk. "It
really needs to come from the Africans themselves," he said. "They may
be the ones to implement it on their own or ask for donor assistance.
Maybe that's when things will change."
In Zambia, USAID has just begun funding its first training sessions
for health workers to perform voluntary circumcision surgery. Emmanuel
Oladipo Otolorin, a regional HIV/AIDS adviser for Johns Hopkins
University's international public health institute, said that African
countries should start training health workers now to perform safe
circumcisions, instead of waiting for further data.
"One cannot ignore these observational studies," Otolorin said by
telephone from Lusaka. "Now many men are going to traditional
circumcisers and some are coming out with terrible complications and
infections. So why don't we strengthen sites that are already
providing facilities on a limited scale?"
In September, Otolorin posted a small note outside a clinic in Lusaka
advertising free circumcisions. He said more than 50 men showed up.
Only a few mentioned that they wanted to be circumcised as a
prevention for HIV; most said they believed circumcision would either
improve their hygiene or sexual satisfaction.
"But can you imagine if we now go out and say, 'Oh, male circumcision
is associated with a lower risk of HIV?' " Otolorin asked. "All the
young men would be queuing up to have this done. We have to be
cautious about this. We know it is not an absolute protection. But
this is an intervention we cannot ignore."
http://www.boston.com/news/globe/health_science/articles/2004/11/16/
circumcised_men_less_likely_to_get_aids/
==========================================
Circumcised men less likely to get AIDS
By John Donnelly, Globe Staff | November 16, 2004
JOHANNESBURG -- Men who are circumcised have a dramatically lower rate
of HIV infection than those who are not, according to new studies in
Africa and India, suggesting that the ancient surgical procedure may
play a role in helping prevent the spread of the deadly virus.
One unpublished household survey in Kenya has shown that uncircumcised
men have an HIV rate that is 11 times greater, while a second study in
India has found uncircumcised men have a seven times higher rate of
infection. Other studies showed that Zambia and Ethiopia had lower
rates of HIV infection in areas of the countries where circumcision
was more common. Researchers have suspected a link between
circumcision and HIV prevention for more than 15 years. In the United
States, studies have shown that high circumcision rates have had a
protective benefit for heterosexual Americans. But most specialists
have not recommended the procedure because they believed that other
factors such as religious and cultural beliefs might explain the link.
The recent Kenya data, however, have given new impetus among some AIDS
experts to focus more attention on the issue. The Kenya study was
completed by the Demographic and Health Surveys, a Maryland-based
independent group that conducts detailed surveys around the world.
Leaders in at least two African countries, Swaziland and Zambia, have
said that, while they want more definitive evidence linking
circumcision with preventing HIV, they say the epidemiological studies
have startled them.
"Watch this. There could be some breakthroughs coming out of this,"
Derek von Wissell, director of Swaziland's National Emergency Response
Council on HIV/AIDS, said in a telephone interview from Mbabane, the
capital. "If the evidence comes through, we could really look at this
as a preventive measure. It's almost as effective as a vaccine. The
effect would be massive."
World Health Organization officials, however, warn that ongoing
clinical trials need to be completed before deciding whether
circumcision should be recommended as a prevention tool against the
spread of HIV. Those studies, underway in Kenya, Uganda, and South
Africa, will be completed in one to three years.
"The numbers are striking, but we have to make sure that's really the
effect from circumcision," said Kevin R. O'Reilly, a WHO specialist on
the treatment and prevention of HIV and AIDS. "We don't know if the
elevenfold increase we're seeing in Kenya is related to circumcision
alone or differences in sex patterns, religious patterns, and other
things."
O'Reilly said that even if male circumcision was shown to help prevent
HIV, "the question is, what do you do with that information? . . . The
preference for or against circumcision among different groups is a
fairly strongly-held conviction. It has a lot to do with group
identify. In tribal circumstances, it might be us vs. them -- we
circumcise and they don't."
He also expressed concern that some men who believe circumcision
prevents HIV might abandon other safe-sex precautions. "We have a long
history in HIV/AIDS prevention learning time. . . . There is no magic
bullet."
Circumcision, the removal of the foreskin of the penis, is one of the
world's oldest and most common surgical procedures. It is part of a
ritual practiced for thousands of years by Jews and Muslims. Many
Christians and people of other faiths also are circumcised, and the
procedure is most often performed on newborn babies boys in the USA.
According to a review of scientific research by the US Agency for
International Development, the inner surface of the foreskin absorbs
HIV up to nine times more efficiently than female cervical tissue.
Circumcision is already known to reduce a man's risk of penile cancer.
A study of 393 men from a clinic in Tuscon, published last month in
the journal Sexually Transmitted Diseases, also found that
circumcision may reduce the risk of cervical cancer in female sexual
partners. That confirmed an earlier five-country study published in
the New England Journal of Medicine.
In Africa, the countries with the highest rates of HIV infection are
in the far south, which have low circumcision rates. Countries in West
Africa and the island nation of Madagascar have lower HIV prevalence
and very high male circumcision rates.
For years, most AIDS experts have said that the lower rates were
largely attributable to large Muslim populations, which generally had
more conservative sexual behaviors than Christian communities.
Conservative religious beliefs and sexual behavior apparently do not
explain some situations for low HIV prevalence. In Madagascar, where
nearly 100 percent of boys are circumcised by puberty, about 10
percent of the population is Muslim, 45 percent Christian, and 45
percent follow traditional beliefs. The island also has high rates of
sexually transmitted infections, which can increase risk for HIV
transmission. And yet the island's HIV prevalence is estimated at 1.4
percent.
"It's an intriguing question why HIV prevalence varies so dramatically
across different parts of Africa as well as parts of Asia," Daniel
Halperin, a USAID expert on HIV prevention, said in an interview from
Washington. "The main, although not the only, factor explaining this
appears to be male circumcision."
But Halperin, who has been one of the most passionate supporters for
more research on male circumcision and health, said that USAID would
not recommend mass circumcision campaigns to lower HIV risk. "It
really needs to come from the Africans themselves," he said. "They may
be the ones to implement it on their own or ask for donor assistance.
Maybe that's when things will change."
In Zambia, USAID has just begun funding its first training sessions
for health workers to perform voluntary circumcision surgery. Emmanuel
Oladipo Otolorin, a regional HIV/AIDS adviser for Johns Hopkins
University's international public health institute, said that African
countries should start training health workers now to perform safe
circumcisions, instead of waiting for further data.
"One cannot ignore these observational studies," Otolorin said by
telephone from Lusaka. "Now many men are going to traditional
circumcisers and some are coming out with terrible complications and
infections. So why don't we strengthen sites that are already
providing facilities on a limited scale?"
In September, Otolorin posted a small note outside a clinic in Lusaka
advertising free circumcisions. He said more than 50 men showed up.
Only a few mentioned that they wanted to be circumcised as a
prevention for HIV; most said they believed circumcision would either
improve their hygiene or sexual satisfaction.
"But can you imagine if we now go out and say, 'Oh, male circumcision
is associated with a lower risk of HIV?' " Otolorin asked. "All the
young men would be queuing up to have this done. We have to be
cautious about this. We know it is not an absolute protection. But
this is an intervention we cannot ignore."
http://www.boston.com/news/globe/health_science/articles/2004/11/16/
circumcised_men_less_likely_to_get_aids/