Researchers find link between foreskin and HIV infection

Published on October 28, 2009 at 2:42 AM · 4 Comments

Randomized clinical trials conducted by researchers in Rakai, Uganda, have revealed a link between the size of foreskin surface area and the risk of male HIV acquisition. The results of the trials have been published in the current issue of AIDS, the leading journal in the field of HIV and AIDS research. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

In recent years, several studies have shown that circumcision reduces the risk of male HIV acquisition by 50-60%, and circumcision is now recommended by WHO/United Nations Joint Programme on HIV/AIDS (UNAIDS) as an HIV prevention strategy. Based on this evidence that the foreskin increases vulnerability to HIV, Dr Godfrey Kigozi and his colleagues hypothesized that the size of the foreskin might be related to the risk of HIV infection.

Eligible candidates for this retrospective cohort study were drawn from the initially HIV-negative participants in the Rakai Community Cohort Study. These men were subsequently enrolled into the randomized trials of male circumcision and had measurement of their foreskin surface area taken following surgery. The researchers then determined HIV acquisition in these men and assessed the association between foreskin size measured after surgery, and the incidence of HIV acquisition while under surveillance prior to circumcision. Their results determined that the risk of male HIV acquisition was significantly increased in men with larger foreskin surface areas.

The researchers point out that their study is unique and their findings therefore need to be replicated. However, these results, in addition to the observational studies and randomized trials, add plausibility to the hypothesis that the foreskin is a tissue vulnerable to HIV acquisition.

Source: AIDS

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Posted in: Men's Health News | Disease/Infection News

Tags: Circumcision, HIV/AIDS, Nursing

ABC, not circumcision

Mark Lyndon

says:

October 28, 2009 at 8:03 AM

Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

The one study into male-to-female transmission showed a 50% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

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A huge waste of resources.

Jack

October 28, 2009 at 1:19 PM

This is a huge waste of resources. This push to cut is funded by guilty people so much wanting there to be a reason to continue RIC (baby genital mutilations) in the US. There is never a good reason to cut off erogenous tissue of any human without consent. Sucking African men into the mutilation culture with misinformation is also shameful. The trials were flawed and even if the small risk reduction is real (about 1.6% risk change) it is a distraction from condom use and the huge risk reduction that gives.

Let's start with condom use and let's not make condoms that much less useful by desensitizing the genitals of men. The only touch organ possessing as rich erogenous innervation as the foreskin is the clitoris. Circumcision deprives man of 2/3ds of the main erogenous zone constituted of the foreskin and the glans. That natural erogenous tissue makes using a condom so much better. Stop with the push for male genital mutilation.

Penis Size, Foreskin and HIV infection

Hugh7

October 28, 2009 at 5:06 PM

As usual with studies promoting circumcision, there are problems: did they control for penis size? Unsurprisingly, bigger foreskins are usually found (or in this case, taken from) bigger penises. Do men with bigger penises have more trouble using condoms? Do they have more confidence and hence more sex? Either could account for the correlation Kigozi et al. found.

Kigozi at al. have published several studies demonising the foreskin, apparently with a view to promoting circumcision, but perhaps that tends to narrow their focus. For example they cut short the study about male transmission to women (Lancet 374;9685, pp 229-37) before it reached statistical significance. It looked as though it was going to show that circumcising men increased the risk to women.

Study is for unprotected sex in Africa only

Kevin

October 28, 2009 at 5:12 PM

While this is academically interesting, I would caution readers not to draw any personal or public policy conclusions. Most importantly, bear in mind that this study involves men having unprotected sex. Currently 1% of the Ugandan population are adult males with HIV/AIDS. Given limited resources, would a good solution to this problem be to train personnel and create facilities to circumcise 15 million Ugandan males so that it might protect approximately one half of one percent of the population (a percentage who are only male), or would it be better to teach the use of condoms and make them available so that the males and females who use them are protected from not only HIV, but syphilis, chlamydia, HPV, and countless other STDs? Further, will a circumsised male see himself as having a license to have more unprotected sex than an uncircumsised male, thereby actually increasing the HIV infection rate? These are questions that need as much study as correlating foreskin area to HIV infection for Ugandan men.