Circumcision of men with HIV does not reduce the risk of
infection for women, according to a study published by The Lancet.
Male circumcision unleashed a wave of optimism among Aids
campaigners three years ago when trials in Kenya, Uganda and South
Africa found foreskin removal more than halved men's risk of
infection by HIV.
Last year, longer-term analysis of one of the trials found the
benefit to be even greater than thought, with a risk reduction of
One of the big questions, though, is whether male circumcision
could also reduce the risk for women who have intercourse with an
The answer, according to a randomised trial carried out in
Uganda, is a clear "no”.
How the study was done
Doctors enrolled 922 uncircumcised Ugandan men aged 15-49 who
were badly infected with HIV but who did not show any symptoms. Half of the group then had circumcision, while the other half remained uncircumcised.
The researchers also enrolled HIV-uninfected women who were
partners of the male volunteers. These numbered 90 women in the
circumcised group, and 70 in the uncircumcised groups.
All participants were intensively schooled in HIV prevention. The trial was halted at a partway stage because it would have been futile and questionable to carry on.
Analysis of data after two years made it clear that there was no
protection: 18% of women in the circumcised group who were
examined at the follow-up point had become infected, as opposed to
12% in the control group.
Most of the infections in the circumcised group occurred within
six months after circumcision.
This may have been because some of the men had intercourse
without giving time for the circumcision wound to heal properly,
thus exposing the woman to HIV-infected blood in the vagina.
Docs disappointed with outcome
That finding was surprising and provides a lesson for programmes
to promote male circumcision as a cheap, effective method of
preventing HIV among men, say the authors.
Men who undergo circumcision must be closely counselled about
strictly observing sexual abstinence until the wound heals, and
about also using condoms to stop infecting their partners.
The doctors, led by Maria Wawer of the Johns Hopkins Bloomberg
School of Public Health in Baltimore, Maryland, say they were
disappointed with the outcome.
They stress, though, that circumcision campaigns are still
Even if women do not directly benefit from male circumcision,
they get an indirect advantage, because the fewer men who are
infected with HIV, the lesser the risk to women.
Questions still remain
A study published the Journal of the
American Medical Association (JAMA) found that the protective
benefit of circumcision to male heterosexuals does not appear to
extend to male homosexuals.
Among 53 567 men who reported having male sexual partners,
researchers found little difference in the rate of HIV infection
between those who were circumcised and those were not.
The theory behind the effectiveness of circumcision is that the
inner foreskin is an easy entry point for HIV. It is rich in
so-called Langerhans cells, tissue that the Aids virus finds
particularly easy to latch on to and penetrate.
Other questions surrounding circumcision campaigns are the need
to ensure that operations are done hygienically and with the full
knowledge and consent of the male. – (Sapa, July 2009)
How a foreskin ups HIV risk