CIRCUMCISED men are nearly seven times less likely to become infected with HIV, according to a study carried out in India, but the practice provides no protection against other sexually transmitted diseases.
Numerous recent studies have suggested that circumcised men are less likely to contract HIV (快猫短视频, 8 July 2000, p 18). But the latest study is the best evidence yet that it is the absence of the foreskin, rather than associated cultural factors, that makes infection less likely.
A team led by Robert Bollinger at Johns Hopkins University Medical School in Baltimore, Maryland, studied 2300 uninfected men in Pune, India, between 1993 and 2000. Just two of the 191 circumcised men in the group caught HIV-1 鈥� an infection rate of 0.7 cases per 100 person-years, compared with 5.5 cases per 100 person-years in the uncircumcised group (The Lancet, vol 363, p 1039).
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However, there was no difference in rates of syphilis or gonorrhoea, as would be expected if circumcised men were less likely to have unsafe sex. 鈥淭here鈥檚 something specific about HIV,鈥� says Bollinger. The foreskin is rich in cells bearing the CD4 receptor that the virus binds to, so this might explain the effect.
Helen Weiss, an expert on sexually transmitted diseases at the London School of Hygiene and Tropical Medicine, says the result is compelling, but thinks it would be premature to recommend circumcision as a preventive measure. The operation is not risk-free, she points out.
Three separate trials to test the idea are under way in Kenya, Uganda and South Africa, but they will not be complete for at least two years. These studies are more rigorous than the Indian one, as volunteers will be assigned randomly to 鈥渃ircumcise鈥� or 鈥渄o not circumcise鈥� groups. 鈥淭he general consensus is that we need to wait for these results to know better whether promotion of male circumcision as an HIV intervention might work,鈥� Weiss says.
