Circumcising men does not protect female partners
BOSTON, 4. February: Researchers at a major scientific conference here warned Sunday that adult male circumcision (omskæring), which may dramatically reduce the risk of HIV transmission in Africa, could raise the risk for women there whose male partners seek the procedure after they are already infected.
Studies presented this week at the 15th annual Conference on Retroviruses and Opportunistic Infections – considered the premier scientific meeting on AIDS each year – are examining in depth new strategies that rely on medical interventions such as the use of drugs or surgical removal of the foreskin to improve the odds against infection.
Three landmark studies in 2005 and 2006 showed that adult men who are circumcised reduce their risk of HIV infection by up to 60 percent, and the World Health Organization last year added the procedure to its list of recommended AIDS prevention measures.
John Mellors, chief of infectious diseases at the University of Pittsburgh, called those circumcision results the “most important finding in HIV prevention in a decade.”
The research raised hopes that circumcision might convey some protection to female partners of HIV-infected men, because circumcised men have fewer genital and urinary tract infections, and it was assumed that the women might have fewer vaginal infections as well.
Scientists also theorized that an infected mans foreskin might be an effective transmitter of the virus – so lack of a foreskin and fewer genital infections might cut the HIV risk.
New studies by scientists from Johns Hopkins University and Makerere University in Kampala, Uganda, have shown, however, that when men who were already HIV-positive were circumcised, it may have raised the risk of infection to their female partners.
The researchers provided circumcisions to one group of HIV-positive men, and set up for comparison purposes a second group of HIV-positive men who were not circumcised. Couples were counseled to use condoms. Then the researchers tracked and compared the health of couples in both groups.
Unexpectedly, the study found similar rates of vaginal infections among women, whether or not their partners were circumcised, and a slightly increased risk for HIV if their infected partners were circumcised.
The HIV risk could have been purely the result of chance, but researchers were alarmed that instead of clearly reducing the danger, it showed a trend toward increasing it.
Dr. Maria Wawer, the Johns Hopkins scientist who led the project, said the disappointing findings were all too familiar in HIV research.
– We all want to find the next step in understanding this incredibly clever virus. No matter where we hit it, it seems to pop up in another direction, she said.
The study found a plausible reason why the women whose HIV-positive partners were circumcised had a higher risk for HIV: The infections were clustered among couples who began sexual activity before the 30 day post-circumcision healing period was completed.
Without complete healing, HIV could pass in blood from the surgical wounds.
The news was not entirely bleak, however. A separate study conducted at Rakai, Uganda, did show some health benefits for women whose male partners were circumcised while HIV-negative.
These women had a 25 percent lower rate of infection with genital herpes; a 50 percent reduction in trichomoniasis – a common sexually transmitted disease caused by a parasite – and a 20 percent reduction in bacterial vaginosis.
These kinds of infections tend to increase the risk of HIV infection in women, but this study was not designed to find out whether that indeed had happened.
Despite the disappointment that male circumcision seemed to offer no protection to female partners of HIV-infected men, Wawer stressed that the procedure will probably still benefit women because if fewer men are infected, they are less likely to pass that infection on to their partners.
– We are sure there will be a population benefit, she said.
Meanwhile, United Nations health agencies said Friday that using a condom is still the safest protection against AIDS after Swiss researchers claimed patients on retroviral drugs do not transmit the virus.
UNAIDS and the World Health Organisation said in a joint statement that they “strongly recommend a comprehensive package of HIV prevention approaches, including correct and consistent use of condoms.”
Kilde: The Push Journal
