Reduced Risk of HIV Among Circumcised Men in India Related to Biology, Not Behavior, Study Says
Men in India who are circumcised are less likely to be HIV-positive than men who are not circumcised because of biological, not behavioral differences, according to a study published in the March 27 issue of the Lancet, Reuters reports (Reuters, 3/25). Some researchers have suggested that circumcised men are less likely to be HIV-positive because they engage in fewer risk behaviors because of their religious beliefs or other cultural factors. Other researchers have suggested that circumcised men have a reduced risk of other sexually transmitted diseases associated with genital ulceration or mucosal inflammation, which can increase the risk of HIV infection, according to the study (Bollinger et al., Lancet, 3/27). Robert Bollinger and colleagues from the Johns Hopkins University Medical School and the National AIDS Research Institute in Pune, India, examined 2,298 HIV-negative men who attended a STD clinic in India. The researchers assessed most of the men a total of four times for about a year and found that uncircumcised men were more than six times as likely to acquire HIV than circumcised men. However, the researchers did not find a similar protective effect against other STDs, including herpes simplex 2, syphilis or gonorrhea (Lancet release, 3/26). Circumcision only had a protective effect against HIV (Lichtarowicz, BBC News, 3/26). "These epidemiological data lend support to the hypothesis that male circumcision protects against HIV-1 infection primarily due to removal of the foreskin, which contains a high density of HIV-1-specific cellular targets, including CD4+ T-lymphocytes and Langerhans cells," the researchers said (Lancet, 3/27).
The study recommends that clinical trials be conducted where culturally appropriate to determine the safety and effectiveness of male circumcision as a means of reducing the spread of HIV. In addition, the study calls for additional research into methods of blocking the entry of HIV into cells contained in the foreskin (Reuters, 3/25). Three trials examining these issues currently are being conducted in Africa, Toronto's Globe and Mail reports. Researchers hope to verify that circumcision is a "true preventative agent" and that as a surgery it does not have high complication rates. They also hope to determine whether men change their sexual behavior after surgery, including whether there is an increase in risk-related behaviors (Strauss, Globe and Mail, 3/26).