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Randomized Controlled Trial Shows Circumcision Does Not Prevent Male-To-Female HIV Transmission

Male circumcision does not prevent the transmission of HIV from men to their female partners, according to a Lancet study conducted in Uganda, Bloomberg reports (Sargent, 7/16).

“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 the human immunodeficiency virus (HIV)” from a female partner, the AFP/Google.com writes. “Last year, longer-term analysis of one of the trials found the benefit to be even greater than thought, with a risk reduction of 65 percent.” However, researchers questioned “whether male circumcision could also reduce the risk for women who have intercourse with an HIV-infected man. The answer, according to a randomised trial carried out in Uganda, is a clear ‘No'” (7/16).

The researchers recruited 922 uncircumcised HIV-infected men between the ages of 15 and 49 for the study, who were then divided into two groups – those who were “immediately circumcised” and those for whom the procedure was “delayed for two years,” Reuters reports (Fox, 7/16).

The researchers also observed nearly 170 uninfected female partners of the men participating in the study, following up with them at six, 12, and 24 months, according to the BBC. The study was “ended early because of what the researchers called the ‘futility’ of carrying on, and the second group were not circumcised,” the BBC writes, adding “[o]nly 92 couples in the immediate circumcision group and 67 in the control group were included in the final analysis” (7/16). The analysis found that “18 percent of the female partners of the circumcised men became infected with the virus compared with 12 percent of the partners of men who hadn’t undergone the procedure,” Bloomberg writes (7/16). 

All participants were told “adherence to safe sexual practices was imperative,” according to the Lancet study. Despite studies that “suggested circumcision … can lower the rate of male-to-female virus transmission from HIV-positive men” the researchers concluded, “[c]ircumcision of HIV-infected men didn’t reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed.” The study was funded by the Bill & Melinda Gates Foundation and received support from NIH and the Fogarty International center (Wawer et. al, 7/18).

Lead author Maria Wawer, from the Bloomberg School of Public Health, “said it was not sensible to recommend men with HIV should not be circumcised, or that there should be any down-scaling of circumcision programmes, because of the overall benefits to both uninfected men and to women,” and the risk of stigmatizing men living with HIV, according to BBC (7/17). Bloomberg writes: The WHO “says that HIV-infected men shouldn’t be denied circumcision if requested, as long as there are no medical reasons to avoid it” (7/16). According to VOA News, “[r]esearchers say the longer term benefits of male circumcision to women still need to be further studied” (Berman, 7/16).

“The findings suggest that strict adherence to sexual abstinence during wound healing and consistent condom use thereafter must be strongly promoted when HIV-infected men receive circumcision,” the authors write in the Lancet study, adding ” that “[c]ircumcising infants and young boys before their sexual debut would mitigate the challenge of male circumcision in HIV-infected men” (7/18).

A related Lancet comment says, “Involvement of women in decision making about circumcision offers an opportunity for enhanced messaging about the risks and benefits of circumcision, for men and for women, and for targeted risk-reduction counselling for HIV-serodiscordant couples” (Baeten et. al, 7/18).

Ugandan Government To Run One-Year Female Condom Campaign

A separate Lancet world report examines the recent announcement by the Ugandan government to “reintroduce the female condom as part of a 1-year pilot programme to give women more options for protected sex and to help the country reverse a recent rise in HIV/AIDS incidence.” The campaign aims to distribute 100,000 female condoms and educate the population about how to use the condoms.

The journal writes: “The move to bring back the female condom is part of Uganda’s struggle to regain the success in the fight against HIV/AIDS in the 1990s. After slashing its HIV/AIDS rate from more than 20 percent to about 6 percent, Uganda saw a leveling off of HIV/AIDS cases and then a slight rise since 2000,” which the government “blames that rise on a shift away from emphasizing condom use in Uganda” (Wadhams, 7/18).