23 July 2009

Circumcision of HIV+ males increases risk to women

For quite a long time now there have been reports of studies that purport to show that male circumcision reduces transmission of HIV and Aids, leading some people to advocate universal male circumcision as a means of combating the pandemic.

There is a study that implies that this approach could be counterproductive. Circumcision of HIV men INCREASES risk to women. | ICGI - Genital Integrity:
A new study published in Lancet shows that women are 50% more likely to contract HIV if they are having sex with circumcised men. Most of the infections were from the time period when the couples began having sex before the wound healed, but the effect continued past that period, indicating that there is no benefit to women from male circumcision. Proponents of mass circumcision plans have long argued that women are protected when men are circumcised, but this study indicates the opposite. The study, like its predecessors, was stopped early.

Medical statisticians may believe that universal male circumcision will statistically reduce the rate of transmission of HIV, but one is dealing with people, not statitstics. The web site in the link is an advocacy site, and not disinterested in this matter, but The Lancet is a reputable medical journal.

The study referred to above shows what simple logic should have shown anyway -- that while circumcision may reduce a male's chance of being infected with HIV, one that male is infected, it does nothing to reduce the chance of his passing on the virus to women.

And the propaganda for universal male circumcision may be counterproductive, in that, human nature being what it is, it could lead circumcised males to believe that they are immune to infection (yes, weirder things have happened -- people are not statistics) and thus become more promiscuous.


Vashti Winterburg said...

I would like to refer you to an article in the NY Times on 20 July 09 on the effectiveness of male circumcision in combating HIV in males in Africa. Yes, This does not directly apply to the incidence of HIV in women, but knowing how Africa is struggling with this issue, it is irresponsible to discourage an effective means of bringing down the overall rate of transmission. From my own church's work in Kenya I know that transmission of HIV is strongly related to the trucking routes in that country and the use of prostitutes. The status of women is in turn a direct predictor of prostitution rates. Unless married, prostitution is frequently the only means that a woman in southern Africa has of supporting herself and her children.

James Higham said...

Well, I'd never thought of that one.

Hugh7 said...

Vashti, the so-called effectiveness of circumcision in protecting men so far amounts to a total of 73 circumcised men (out of 5,400) not getting HIV in less than two years, while 327 circumcised men dropped out, their HIV status unknown. So it's entirely possible that circumcision does not protect men at all. If that is the case - and especially if circumcision encourages men to think they are safe and need not use condoms - it would be irresponsible to encourage circumcision.

You are quite right about the status of women, and circumcising men disempowers women, whether wives or prostitutes, from demanding condoms.

By the enthusiasts' own figures, circumcision is as effective as a supply of condoms 40% of which have holes.

Still other studies have shown that a lot of male-male sex goes unrecorded, and a lot of non-sexual transmission. Circumcision campaigns could be barking up the wrong tree - or debarking the wrong trees!

Joe said...

Vashti - I would like to refer you to a recent article in AidsMap which presented the results of a model on interventions in South Africa, circumcision provided (in there words not mine) surprisingly little additional benefit. At the very least we know that there is no direct benefit to women. Any risk compensation could push the rates up for women who, as you pointed out, are already in a weak position.

If it is true that their risk is increase if their partner is HIV+ and circumcised this could be catastrophic considering that infection is more efficient in the direction of women in the first place. This is not a well thought out intervention only a overly hyped one. It's one they want, a set it and forget it type of intervention. It's half-baked and will likely result in higher prevalence of HIV over all, likely in women.


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