Although the researchers said that the study's findings are not statistically significant, they did say that male circumcision does not provide protection from HIV to female partners and that the procedure could increase the risk of HIV transmission if HIV-positive men have sex before the circumcision is healed.
For the study, Maria Wawer of Johns Hopkins University and colleagues enrolled 1,015 HIV-positive men who randomly were chosen to be circumcised either immediately or after waiting two years. Of the 770 married men in the group who were asked to invite their wives to participate in the study, 566 did so. Among the women, 245 were HIV-negative at the start of the study. The researchers focused on the 161 couples who enrolled at the same time and in which the men were HIV-positive and the women were HIV-negative. All the men and women were given information about HIV-prevention methods other than male circumcision, wound care and abstaining from sex after circumcision, according to the Times. The men also were given no-cost condoms, and the couples were provided with counseling and HIV tests.
Men in 93 of the couples had an immediate circumcision, compared with 68 men in the control group who delayed having the procedure for two years. In both groups, the HIV incidence was highest during the first six-month follow-up period: 27.3 in the immediate circumcision group and 17.8 in the delayed circumcision group. HIV incidence decreased during the rest of the study period, according to the Times. Researchers recorded an incidence of 5.7% in the immediate circumcision group and an incidence of 4.1% in the delayed group.
Higher HIV incidence was recorded among couples who resumed sex more than five days earlier than when a health worker confirmed that circumcision wounds had healed completely, compared with couples who resumed sex within five days of confirmed wound healing, according to the Times.
Rates of condom use, bacterial vaginal infections, vaginal discharge, painful urination and urinary tract infections were the same among women in both groups, according to the study (Altman, New York Times, 2/4).
A similar study conducted by the researchers in Uganda found a 25% lower rate of genital herpes among women whose male partners were HIV-negative when circumcised. The study also found a 50% reduction in the sexually transmitted infection trichomoniasis and a 20% reduction in bacterial vaginosis among women whose partners were HIV-negative when undergoing the procedure (Russell, San Francisco Chronicle, 2/4).
According to the researchers, the study's findings underscore the need for education among men who are circumcised and their female partners. Wawer said that because the findings are not statistically significant, more research is needed to determine the benefits of male circumcision among men and their partners. In addition, further research is needed to determine ways to reduce the risks associated with resuming sex before the circumcision is healed, Wawer said (New York Times, 2/4).
Wawer added that although the study did not find a reduced risk of HIV among women whose HIV-positive partners were circumcised, male circumcision likely still will benefit women because fewer men within a population will be HIV-positive, and thus less likely to transmit the virus. "We are sure there will be a population benefit" associated with male circumcision, Wawer said (San Francisco Chronicle, 2/4).