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Male circumcision for HIV prevention and more
July 24, 2007Should adult male circumcision be recommended for HIV prevention in the US?
Three clinical trials in Africa found that adult male circumcision reduced the risk of men acquiring HIV infection from heterosexual sex by 51-60%. While adult male circumcision may also have a role to play in preventing HIV transmission in the US, say scientists at the US Centers for Disease Control (CDC) in a paper in PLoS Medicine, "the extent of this role on a population basis is unknown."
Patrick Sullivan (Division of HIV/AIDS Prevention,CDC) and colleagues argue that the potential impact of adult male circumcision on HIV transmission rates in the US is hard to predict, given the many differences between the underlying HIV epidemics in Africa and the US, differences in the prevalence of male circumcision in Africa and the US, and the considerable gaps in knowledge that exist regarding the potential impact of circumcision on HIV transmission by male-male sex.
"The HIV epidemics in Africa are substantially different from the US epidemic," they say. The predominant mode of HIV transmission in Africa is heterosexual sex whereas the US has a concentrated HIV epidemic with most sexual transmission occurring among men who have sex with men (MSM). The African trials did not study MSM. While some observational studies have suggested that circumcised MSM in the US may have a decreased risk of HIV infection, say the authors, it is impossible to draw firm conclusions from such observational research, which is prone to bias.
Adult male circumcision will likely have the largest impact in populations where circumcision has been rare, they say. Yet in the US circumcision is already very common-hospital discharge data show that in 1999 around two thirds of all newborn boys were circumcised.
Nevertheless, based on the data from the three African clinical trials, Sullivan and colleagues conclude that "it is likely that circumcision will decrease the probability of a man acquiring HIV via penile-vaginal sex with an HIV-infected woman in the US." Until public health recommendations are available for the US, they say, "some sexually active men may consider circumcision as an additional HIV prevention measure, but should do so only in consultation with their physician or health care provider, and with a clear understanding of the costs and risks of circumcision and the need to continue use of other, proven prevention measures (e.g., reducing the numbers of sex partners and using condoms consistently and correctly). Men who choose to be circumcised should also be counseled about the importance of refraining from sexual intercourse following circumcision, until wound healing is complete. Men should also understand that male circumcision has only proven effective in reducing the risk of infection through insertive vaginal sex."
Citation: Sullivan PS, Kilmarx PH, Peterman TA, Taylor AW, Nakashima AK, et al. (2007) Male circumcision for prevention of HIV transmission: What the new data mean for HIV prevention in the United States. PLoS Med 4(7): e223.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040223
Public Library of Science
"The HIV epidemics in Africa are substantially different from the US epidemic," they say. The predominant mode of HIV transmission in Africa is heterosexual sex whereas the US has a concentrated HIV epidemic with most sexual transmission occurring among men who have sex with men (MSM). The African trials did not study MSM. While some observational studies have suggested that circumcised MSM in the US may have a decreased risk of HIV infection, say the authors, it is impossible to draw firm conclusions from such observational research, which is prone to bias.
Adult male circumcision will likely have the largest impact in populations where circumcision has been rare, they say. Yet in the US circumcision is already very common-hospital discharge data show that in 1999 around two thirds of all newborn boys were circumcised.
Nevertheless, based on the data from the three African clinical trials, Sullivan and colleagues conclude that "it is likely that circumcision will decrease the probability of a man acquiring HIV via penile-vaginal sex with an HIV-infected woman in the US." Until public health recommendations are available for the US, they say, "some sexually active men may consider circumcision as an additional HIV prevention measure, but should do so only in consultation with their physician or health care provider, and with a clear understanding of the costs and risks of circumcision and the need to continue use of other, proven prevention measures (e.g., reducing the numbers of sex partners and using condoms consistently and correctly). Men who choose to be circumcised should also be counseled about the importance of refraining from sexual intercourse following circumcision, until wound healing is complete. Men should also understand that male circumcision has only proven effective in reducing the risk of infection through insertive vaginal sex."
Citation: Sullivan PS, Kilmarx PH, Peterman TA, Taylor AW, Nakashima AK, et al. (2007) Male circumcision for prevention of HIV transmission: What the new data mean for HIV prevention in the United States. PLoS Med 4(7): e223.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040223
Public Library of Science
Circumcision News and Current Circumcision Events RSSMale circumcision efforts lag in Africa despite evidence of dramatic impact in preventing HIV
With millions of lives at stake over the next two decades, researchers and advocates at the AIDS 2008 Conference today called on the global health community to ramp up male circumcision to significantly reduce risk of HIV infection in Africa, and to move quickly to integrate the life-saving procedure into other comprehensive efforts to prevent transmission of the disease in the vulnerable nations of eastern and southern Africa.
New Male Circumcision Device for HIV Prevention Studied by NewYork-Presbyterian/Weill Cornell
With the recent endorsement by the World Health Organization (WHO) and scientists worldwide of adult male circumcision as an important strategy for HIV prevention, there is increased urgency to develop safe and cost-effective circumcision services. This is especially the case in Africa where HIV/AIDS continues to spread at an epidemic rate.
Is infant male circumcision an abuse of the rights of the child?
Circumcision is one of the commonest surgical procedures performed on males. Opponents argue that infant circumcision can cause both physical and psychological harm, while recent evidence shows that circumcision is medically beneficial.
The release of new data from the HVTN 502 HIV vaccine study
The new analyses revealed today from the STEP HIV vaccine clinical trial are both disappointing and puzzling. At this time, the data offer no clear explanations as to why the vaccine showed no measurable efficacy or why among individuals with background immunity to the adenovirus vector, there were more HIV infections in the vaccinees as compared to those in the placebo group.
Male circumcision overstated as prevention tool against AIDS
In new academic research published today in the online, open-access, peer-reviewed scientific journal PLoS ONE, male circumcision is found to be much less important as a deterrent to the global AIDS pandemic than previously thought.
Scientists, public health leaders call for coordination in HIV prevention research
HIV prevention research was responsible for the recent revelation that male circumcision can play an important role in protecting men from infection with the deadly virus.
Circumcision: A proven strategy to prevent HIV
Male circumcision significantly reduces the risk of acquiring HIV in young African men, according to a study led by University of Illinois at Chicago professor of epidemiology Robert Bailey.
First large-scale HIV vaccine trial in South Africa opens
A large-scale clinical trial of a candidate HIV vaccine—which previously showed promise in smaller studies in the United States and elsewhere—has now opened in South Africa.
Circumcision for prevention of HIV: new analysis demonstrates cost-effectiveness
A team of researchers who conducted a landmark trial in Orange Farm, South Africa, which concluded that male circumcision can sub stantially reduce the risk of becoming infected with HIV, have now studied the economic aspects of this approach to preventing HIV/AIDS.
Male circumcision reduces HIV risk, study stopped early
A University of Illinois at Chicago study has been stopped early due to preliminary results indicating that medical circumcision of men reduces their risk of acquiring HIV during heterosexual intercourse by 53 percent.
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