Study finds
circumcision may protect men from HIV
Channel News Asia, 31
January 2000
http://www.channelnewsasia.com/archive/2000/1/31/world19439.htm
Circumcision may somehow protect men from
sexual transmission of the AIDS virus, researchers said on Sunday, but they
admitted they do not have a clue why.
A study in Uganda aimed at examining how
couples infect one another found two things seemed to protect people - being
older and being circumcised.
"Acquisition of HIV did not occur in any of
the circumcised men," Dr. Thomas Quinn of Johns Hopkins University in
Baltimore, who led the study, told the 7th Conference on Retroviruses and
Opportunistic Infections, a meeting of AIDS researchers.
"Age, independent of viral load, appeared to
have a protective effect," Quinn added. The highest transmission rate was in
people 15 to 29 years old.
Quinn's team, working with 15,000 people in
the Rakai district of Uganda, also found that people did not pass on the virus
to their partners if they had a naturally low level of HIV in the blood - in
this case, 1,500 copies according to standard measures.
He found that the more virus people had in
their blood, the more likely they were to pass it on. There were no
differences in women infecting men or men infecting women.
Quinn said his team was one of the first to
actually go out and test the idea where HIV is raging the worst. More than 23
million people in sub-Saharan Africa are infected with HIV.
The findings might suggest ways of stemming
the epidemic.
Telling people to abstain from sex or use
condoms has not worked, and the drugs that keep the virus at bay in some
patients in rich countries are not available in the poor countries hardest hit
by the epidemic.
But the study suggests that using drugs to
keep the virus at lower levels, or a vaccine that might do the same without
quite curing a patient, might help.
Quinn said he was at a loss to explain why
circumcision might affect a man's risk of being infected by a woman.
Circumcision hailed
as way to curb Aids
Bryan Appleyard
The Sunday Times, UK
http://www.sunday-times.co.uk
NEW evidence suggests that circumcision of
all male babies could help to halt the global Aids epidemic. With 50m living
cases and more than 16m deaths, the disease is now the worst human health
disaster since the Black Death.
The thesis - laid out in a scientific paper
to be published soon - seems likely to create huge controversy as it
represents a complete change in accepted ideas about the transmission of Aids.
One of the paper's authors, Roger Short,
professor of obstetrics at Melbourne University and a respected scientist with
long experience of Aids-ravaged areas, has been told he cannot address the
subject at a forthcoming international conference.
Short and his co-author, Dr Robert Szabo,
are convinced that a high level of receptors - sites to which invading
organisms attach themselves - on the inside of the foreskin make it
responsible for transmission.
Short and Szabo noted a sharp difference in
the prevalence of HIV infection in the "Aids belt" countries in sub-Saharan
Africa. In some areas the infection rates are as high as 25%, in others as low
as 1%. The lower infection rates were clearly associated with the practice of
male circumcision.
"The presence of an intact foreskin," says
the Short-Szabo paper, "has consistently been shown to be the single most
significant factor associated with the much higher prevalence of HIV in
countries of the Aids belt."
The link is stronger than with more familiar
indicators such as promiscuity, other sexually transmitted diseases and
multiple marriage.
Even more startling evidence came from a
recent study in Uganda, reported in February. This showed that among a large
group of "discordant couples" - where one is infected and one not - no
circumcised males became infected over 30 months, even though their wives were
HIV-positive. Short describes these results as "staggeringly significant".
Outside Africa there is the same pattern.
Countries with low circumcision rates, such as Thailand, India and Cambodia,
have between 10 and 50 times the rates of infection compared with countries
with high circumcision rates, such as the Philippines, Bangladesh and
Indonesia.
Once they get ethical clearance in
Australia, Short and Szabo intend to test their conclusions by applying live
HIV virus to newly removed foreskins to check its rate of uptake. They could
have definite results within weeks.
If experimentally confirmed, the
implications are radical. Short and Szabo believe that about 80% of male HIV
infections in the world happen through the foreskin.
Short is not advocating adult circumcision,
a painful and potentially dangerous operation. But future generations could be
saved if mass circumcision began now.
Short believes his findings should be spread
globally, as rapidly as possible.
"There has been insufficient focus on
prevention," he said, "and too much emphasis on the search for a vaccine."
Despite the billions poured into research, there is still no sign of an Aids
vaccine.
The crisis in sub-Saharan Africa - where
life expectancy rates at birth as a result of Aids have dropped from 59 to 44
- is out of control.
"The whole of my life's prejudice has been
anti-circumcision," said Short.
"I've written papers against it. I didn't
believe the benefits outweighed the costs. If God had made us the way we were,
why remove a sound organ? But I have been totally converted."
