Male Circumcision Might Reduce Risk of Female-to-Male HIV Transmission by About 60%, Study Says
Male circumcision might reduce the risk of men contracting HIV through sexual intercourse with women by about 60%, according to a study published in the November issue of PLoS Medicine, BBC News reports (BBC News, 10/25). French and South African researchers conducted a randomized, controlled clinical trial that enrolled 3,274 HIV-negative, uncircumcised men ages 18 to 24 living in South Africa. Half of the men were randomly assigned to be circumcised, and the other half served as a control group, remaining uncircumcised. The researchers continually tested the men for HIV infection over 21 months (Sample, Guardian, 10/25). During the trial, they recorded 20 HIV infections among the circumcised men and 49 infections among the uncircumcised men (Auvert et al., PLoS Medicine, November 2005). The study was conducted in the Orange Farm area near Johannesburg, South Africa, where male circumcision during adulthood is common, according to BBC News (BBC News, 10/25). Preliminary results from the study were presented in July at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro, Brazil (Kaiser Daily HIV/AIDS Report, 7/27). Although more than 40 studies since 1989 have found lower HIV rates among circumcised men, this study is the first to test circumcision as an "active intervention" for HIV prevention, Newsweek reports (Summers, Newsweek, 10/31).
The November 2005 issue of PLoS Medicine also contains an editorial and two perspectives on the study, which are summarized below.
- "A Landmark Paper in HIV Research?": The trial was approved by two "experienced ethics boards" and did not exclude HIV-positive people from taking part, a PLoS Medicine editorial says. Both "ethical questions" and "scientific concerns" about the trial were raised during a peer review before the results were published, the editorial says, adding that if the findings of the study prove "correct" in further research, "then this is a study that offers hope" (PLoS Medicine, November 2005).
- "The First Randomised Trial of Male Circumcision for Preventing HIV: What Were the Ethical Issues?" Peter Cleaton-Jones: The Human Research Ethics Committee -- the institutional review board of the University of the Witwatersrand in South Africa -- decided that the study needed to be conducted "urgently" because it had "local importance," Cleaton-Jones, the ethics committee's chair, writes in a PLoS perspective. The committee approved the study because it dealt with HIV infection related to pregnant women, because the standard of care in South Africa at the time did not include antiretroviral treatment after HIV-positive tests, because no "firm evidence" existed that linked circumcision to a reduced risk of HIV transmission in men through sexual intercourse with women, and because males are circumcised during adulthood in many African cultures, according to Cleaton-Jones (Cleaton-Jones, PLoS Medicine, November 2005).
- "Does Male Circumcision Prevent HIV Infection?" Nandi Siegfried: Although the researchers should be "congratulated for attempting and successfully completing a trial as complex as this," they did not report "how the randomization sequence was generated," used an "unusual form of allocation" to divide the trial participants into study groups and did not inform trial participants of their HIV status, Siegfried, a South African Nuffield Medical Fellow at the University of Oxford, writes in a PLoS perspective. The researchers "are right to argue that we need to seriously consider circumcision as a potential prevention method, but it seems wise to be more cautious in making recommendations for policy," Siegfried says (Siegfried, PLoS Medicine, November 2005).