December 14, 2006
Circumcision Halves H.I.V. Risk, U.S. Agency Finds
By DONALD G. McNEIL Jr.
Circumcision appears to reduce a man's risk of
contracting AIDS from heterosexual sex by half, United
States government health officials said yesterday, and
the directors of the two largest funds for fighting
the disease said they would consider paying for
circumcisions in high-risk countries.
The announcement was made by officials of the National
Institutes of Health as they halted two clinical
trials, in Kenya and Uganda, on the ground that not
offering circumcision to all the men taking part would
be unethical. The success of the trials confirmed a
study done last year in South Africa.
AIDS experts immediately hailed the finding. "This is
very exciting news," said Daniel Halperin, an H.I.V.
specialist at the Harvard Center for Population and
Development, who has argued that circumcision slows
the spread of AIDS in the parts of Africa where it is
In an interview from Zimbabwe, he added, "I have no
doubt that as word of this gets around, millions of
African men will want to get circumcised, and that
will save many lives."
Uncircumcised men are thought to be more susceptible
because the underside of the foreskin is rich in
Langerhans cells, sentinel cells of the immune system,
which attach easily to the human immunodeficiency
virus, which causes AIDS. The foreskin also often
suffers small tears during intercourse.
But experts also cautioned that circumcision is no
cure-all. It only lessens the chances that a man will
catch the virus; it is expensive compared to condoms,
abstinence or other methods; and the surgery has
serious risks if performed by folk healers using dirty
blades, as often happens in rural Africa.
Circumcision is "not a magic bullet, but a potentially
important intervention," said Dr. Kevin M. De Cock,
director of H.I.V./AIDS for the World Health
Sex education messages for young men need to make it
clear that "this does not mean that you have an
absolute protection," said Dr. Anthony S. Fauci, an
AIDS researcher and director of the National Institute
of Allergy and Infectious Diseases.
Circumcision should be used with other prevention
methods, he said, and it does nothing to prevent
spread by anal sex or drug injection, ways in which
the virus commonly spreads in the United States.
The two trials, conducted by researchers from
universities in Illinois, Maryland, Canada, Uganda and
Kenya, involved nearly 3,000 heterosexual men in
Kisumu, Kenya, and nearly 5,000 in Rakai, Uganda.
None were infected with H.I.V. They were divided into
circumcised and uncircumcised groups, given safe sex
advice (although many presumably did not take it), and
The trials were stopped this week by the N.I.H. Data
Safety and Monitoring Board after data showed that the
Kenyan men had a 53 percent reduction in new H.I.V.
infection. Twenty-two of the 1,393 circumcised men in
that study caught the disease, compared with 47 of the
1,391 uncircumcised men.
In Uganda, the reduction was 48 percent.
Those results echo the finding of a trial completed
last year in Orange Farm, a township in South Africa,
financed by the French government, which demonstrated
a reduction of 60 percent among circumcised men.
The two largest agencies dedicated to fighting AIDS
said they would now be willing to pay for
circumcisions, which they have not before because
there was too little evidence that it worked.
Dr. Richard G. A. Feachem, executive director of the
Global Fund to Fight AIDS, Tuberculosis and Malaria,
which has almost $5 billion in pledges, said in a
television interview that if a country submitted
plans to conduct sterile circumcisions, "I think it's
very likely that our technical panel would approve
Dr. Mark Dybul, executive director of President Bush's
$15 billion Emergency Plan for AIDS Relief, said in a
statement that his agency "will support implementation
of safe medical male circumcision for
H.I.V./AIDS prevention" if world health agencies
He also warned that it was only one new weapon in the
fight, adding, "Prevention efforts must reinforce the
A.B.C. approach — abstain, be faithful, and correct
and consistent use of condoms."
Researchers have long noted that parts of Africa where
circumcision is common — particularly the Muslim
countries of West Africa —
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