Male Circumcision Might Reduce Risk of Female-to-Male HIV Trans-
mission by About 60%, Study Says
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01 Nov 2005
http://www.kaisernetwork.org
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
http://medicine.plosjournals.org/perlserv/?request=get-
document&doi=10.1371/journal.pmed.0020298 PLoS Medicine,
http://news.bbc.co.uk/2/hi/health/4371384.stm BBC News reports
(BBC News, 10/25). French and South African researchers con-
ducted 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 cir-
cumcised, and the other half served as a control group, remain-
ing uncircumcised. The researchers continually tested the men
for HIV infection over 21 months (Sample,
http://www.guardian.co.uk/science/story/0,3605,1599979,00.html
Guardian, 10/25). During the trial, they recorded 20 HIV infec-
tions among the circumcised men and 49 infections among the un-
circumcised men (Auvert et al., PLoS Medicine, November 2005).
The study was conducted in the Orange Farm area near Johannes-
burg, South Africa, where male circumcision during adulthood is
common, according to BBC News (BBC News, 10/25). Preliminary re-
sults from the study were presented in July at the
http://www.ias-2005.org/ 3rd International AIDS Society Confer-
ence on HIV Pathogenesis and Treatment in Rio de Janeiro, Brazil
(http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1
&DR_ID=31647 Kaiser Daily HIV/AIDS Report, 7/27). Although more
than 40 studies since 1989 have found lower HIV rates among cir-
cumcised men, this study is the first to test circumcision as an
"active intervention" for HIV prevention,
http://msnbc.msn.com/id/9806505/site/newsweek/ Newsweek reports
(Summers, Newsweek, 10/31).
Related Articles
The November 2005 issue of PLoS Medicine also contains an edito-
rial and two perspectives on the study, which are summarized be-
low.
http://medicine.plosjournals.org/perlserv/?request=get-
document&doi=10.1371/journal.pmed.0020293 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).
http://medicine.plosjournals.org/perlserv/?request=get-
document&doi=10.1371/journal.pmed.0020287 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
http://www.wits.ac.za/ University of the Witwatersrand in South
Africa -- decided that the study needed to be conducted "ur-
gently" because it had "local importance," Cleaton-Jones, the
ethics committee's chair, writes in a PLoS perspective. The com-
mittee 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 af-
ter 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).
http://medicine.plosjournals.org/perlserv/?request=get-
document&doi=10.1371/journal.pmed.0020393 Does Male Circumci-
sion Prevent HIV Infection? Nandi Siegfried: Although the re-
searchers should be "congratulated for attempting and success-
fully completing a trial as complex as this," they did not re-
port "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 http://www.ox.ac.uk/ University of Oxford, writes in a
PLoS perspective. The researchers "are right to argue that we
need to seriously consider circumcision as a potential preven-
tion method, but it seems wise to be more cautious in making
recommendations for policy," Siegfried says (Siegfried, PLoS
Medicine, November 2005).
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