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06 January 2011

Circumcision vs AIDS?

Why are more and more experts promoting adult male circumcision as an effective tool to reduce the risk of HIV infection in men?

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Governments and AIDS activists around the world, especially in developing countries, are promoting medical circumcision (i.e. the surgical removal of the penis’ foreskin) for sexually active young men as a cost-effective and efficient method to reduce the risk of HIV transmission and infection.

Risk reduction

Several scientific studies suggest that circumcised men are less likely to contract HIV/AIDS than those of their peers who have not had the cut. According to the World Health Organisation, “there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%”. In other words, circumcised HIV-negative men are less likely to get the virus from female sexual partners who happen to carry the virus.

Experts believe that mass male circumcision in sub-Saharan Africa could prevent some 4 million or more new adult infections and millions of deaths over a period of 20 years.

Several African countries, including Botswana, Kenya, Rwanda and Namibia have added circumcision to their HIV prevention arsenal. In Zimbabwe, a big effort is underway to circumcise 80% of young men aged between 15 and 29, while a ten-year programme in Zambia aims to deliver the cut to more than 2.5 million guys.

South Africa’s Treatment Action Campaign supports the responsible roll-out of voluntary circumcision and last year, Zulu King Goodwill Zwelethini issued an edict to promote the procedure in KwaZulu-Natal.

A moist and warm hiding place?

So why should having your foreskin cut off make you any less vulnerable to HIV? Scientists working in this area have come up with a number of theories, foremost among them the fact that the inner surface of the foreskin has a high concentration of cells which contain HIV receptors that act as portals through which the virus may enter the body. When exposed to bodily fluids, such as semen, which are tainted with HIV, these susceptible cells make men particularly vulnerable to infection. Remove them together with the foreskin and the risk is significantly reduced.

Other theories include the fact that small tears in the foreskin which may develop during intercourse may create particularly effective HIV entry points and the observation that the foreskin traps the virus in a warm, moist environment near the surface of the penis that allows it to survive for longer.

Only partial protection

Researchers are quick to point out that just because a man is circumcised doesn’t mean that he is HIV-negative or that he can not contract the virus. The procedure only provides partial protection from HIV transmission and infection and should simply be considered as one part of a comprehensive, multi-pronged HIV-prevention strategy in which other methods that are known to be effective, including condom use and sexual fidelity, remain absolutely crucial.

A quick snip

Just in case you were wondering, adult medical circumcision is a quick and relatively pain-free procedure. It’s done under local anaesthetic and typically takes only 10 to 20 minutes to complete. You can expect a minor amount of soreness and discomfort once the anaesthetic has worn off, will probably be required to come back for several follow-up treatments and asked to abstain from sex for six weeks or so.

Controversy

But not everyone agrees that circumcision is effective or even desirable in HIV-prevention. Critics claim that there is still too little convincing scientific evidence that the procedure does in fact lower the HIV infection risk for men. They claim that the studies carried out until now provide conflicting results and argue that it is more important to emphasise safer sex education than to advocate male circumcision.

Opponents also point out that circumcision can only provide limited protection for heterosexual males, but not for women and can lead to negative changes in men’s sexual behaviour and perception of risk. In a recent survey among nearly 500 African women some expressed fears that widespread circumcision may make sex and safer sex less negotiable in their relationships, lead to a greater incidence of gender-based violence and even an increased promotion of female genital mutilation.

The majority of experts and AIDS activists seem to agree, however, that there are sufficiently good reasons to promote voluntary male circumcision as part of the broader fight against the spread of the virus. Whether you are circumcised yourself or not, remember to be aware of your HIV status, always wear a condom and be faithful, open and honest to your sexual partners.

Andrew Luyt, Health24, January 2011

 
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