AFRICA: Male circumcision makes women more vulnerable to HIV

A recent study has shown a 50% increase in HIV infection in the female partners of the recently circumcised. This preliminary data seemed to catch researchers back on their heels as they rushed to assure the world that circumcision is still a valid approach for men at a UN consultation in Switzerland on the potential impact of male circumcision.

Female researchers were quick to remind those in attendance that women’s concerns should not be shunted aside.

“Women are already so vulnerable in this epidemic,” said Jennifer Kates, an AIDS expert at the Kaiser Family Foundation who is not connected to the study. “We need to be particularly careful about anything that could put them at even greater risk.”

“We need to err on the side of caution to protect women in any future male circumcision program,” said Dr. Maria Wawer, the study’s lead investigator, a researcher at Johns Hopkins Bloomberg School of Public Health.

The AP article makes the highly questionable statement that “The preliminary results do not call into question the utility of circumcision as a way to prevent AIDS in Africa.” Clearly, the utility is called into question when the HIV infection savings in men is offset by a loss in women. Moreover, AP’s story, carrying the misleading headline “Circumcision may lift HIV risk … ,” goes to great pains to endorse male circumcision.

Human rights activists believe this data may be used to completely subordinate ethical concerns for consent requirements and push for infant or childhood circumcision.

The AFP story that follows the AP article, below, explains that a thousand men are being followed to determine the effect of HIV-infected, circumcised men on their female partners’ vulnerability to HIV infection.

Text of stories after the jump. [Links to original stories now dead.]

Circumcision may lift HIV risk for women

Circumcision may reduce men’s chances of contracting HIV by up to 60 percent — but early results suggest the procedure may put women at increased risk of infection, according to preliminary data presented Tuesday.

Early results announced at a U.N. consultation in Switzerland on the potential impact of male circumcision on AIDS in Africa suggested that if HIV-positive men do not abstain from sex while healing from circumcision surgery, their female partners might have a higher chance of catching HIV from them.

However, experts said the results were not conclusive — and highly susceptible to other factors, such as condom use — demonstrating the difficulties of utilizing circumcision in HIV prevention in sub-Saharan Africa, where more than 60 percent of those with AIDS are women.

Previous studies have confirmed the dramatic impact circumcision has in cutting men’s HIV infection rates, but a big question has been the resulting effect on women.

The first evidence — though very preliminary — suggests there is a period immediately following surgery when men may more easily transmit the virus to their female partners.

“Women are already so vulnerable in this epidemic,” said Jennifer Kates, an AIDS expert at the Kaiser Family Foundation who is not connected to the study. “We need to be particularly careful about anything that could put them at even greater risk.”

Researchers at the Rakai Health Sciences Program and Makerere University in Uganda and the John Hopkins Bloomberg School of Public Health in the U.S. tracked 997 HIV-positive men in Uganda and their female partners.

Among 70 men with HIV who underwent circumcision, 11 of their female partners became infected with the virus in the month after the surgery. In contrast, only four partners of 54 uncircumcised men with HIV in the control group caught the virus — nearly half the rate, early results showed.

Researchers said the results suggest increased HIV transmission from men who have sex before they had properly healed.

However, they said the numbers so far were too small to be statistically significant, and left open the possibility that the higher rates were due to chance; both groups of men and women were given repeated HIV prevention education and free condoms.

Experts said the study showed the importance of finding ways to protect women in the search for ways to fight AIDS.

“We need to err on the side of caution to protect women in any future male circumcision program,” said Dr. Maria Wawer, the study’s lead investigator, a researcher at Johns Hopkins Bloomberg School of Public Health.

More than 60 percent of AIDS patients in sub-Saharan Africa are women. The social and economic inequalities between men and women are thought to be responsible for the elevated rates of infection in women, with many women trapped in relationships with unfaithful men.

The preliminary results do not call into question the utility of circumcision as a way to prevent AIDS in Africa.

But “while male circumcision has extraordinary potential to prevent HIV infection, these new findings remind us that we must proceed with thought and care in developing strategies to expand male circumcision in Africa,” said Dr. Kevin De Cock, director of WHO’s AIDS department. “Circumcision is an additional prevention strategy rather than a
replacement for anything else.”

Reference

Cheng, Maria. Circumcision may lift HIV for women. AP/Yahoo. March 6, 2007.

http://news.yahoo.com/s/ap/20070307/ap_on_he_me/aids_circumcision&printer=1;_ylt=AqC7uCgW7MQKHg2clrIJd3Ra24cA

Early data from a trial in Uganda shows that policymakers must be prudent when including circumcision among their tactics for fighting AIDS, researchers said on Tuesday.

Last year, three groundbreaking studies conducted in Africa found that male circumcision halved a man’s risk of being infected by the human immunodeficiency virus (HIV).

That discovery ignited hopes that the flagging quarter-century-old war against AIDS in Africa could be transformed by a simple, low-cost operation.

The new trial, funded by the Bill and Melinda Gates Foundation, explores a different angle of the circumcision story — to see whether men who are infected with HIV and are circumcised are any less likely to infect their female partner.

US and Ugandan researchers are following 997 HIV-infected men in Rakai, Uganda. Some of them have been given circumcision, while the others have remained uncircumcised to act as a comparison.

A proportion of volunteers in both groups had uninfected long-term female partners at the start of the study. These women were also enrolled and monitored.

A review at the study’s six-month mark looked at 70 couples in the “circumcised” group and found that 11 of the women had become infected. Among 54 couples in the “uncircumcised” group, four women had become infected.

The study is still underway and the data is not considered conclusive.

But the researchers said they were concerned, as several of the infections had been transmitted by men who had had sex before their wounds had fully healed from the circumcision surgery.

The AIDS virus can be carried in the blood, as well as in semen.

This means that, before circumcision can be universally endorsed as a prevention strategy, men and women have to be fully aware about the need to refrain from intercourse for a month or so while the penile wound has healed, the researchers said.

Both partners must be fully versed in safe-sex awareness, especially in condom use.

“We need to err on the side of caution to protect women in the context of any future male circumcision programme,” said the study’s lead scientist, Maria Wawer of the Johns Hopkins Bloomberg School of Public Health.

“Women make up a majority of people living with HIV in Africa, and these results demonstrate that women need to be educated about the risks and benefits of male circumcision,” she said in a press release.

If the finding about infection from post-operative wounds is taken into account, the trial found that there was no protection to partners of HIV-infected, circumcised men within the first six months of surgery.

Circumcised men, though, had a 50-percent lower rate of genital ulceration.

The next step is to see whether that picture changes over the longer term.

The data was released on Tuesday as a contribution to a meeting in Montreux, Switzerland, gathering the UN’s World Health Organisation (WHO) and UNAIDS.

The two agencies are mulling the outcome of the three big trials to weigh how far, and how fast, they should endorse circumcision as a prevention policy.

WHO expert Kevin De Cock stressed the need for caution and good preparations.

“While male circumcision has extraordinary potential to prevent HIV infection, these new findings remind us that we must proceed with thought and care in developing male circumcision in Africa,” said De Cock.

Volunteers in the Rakai study were repeatedly given safe-sex counselling and provided with free condoms. Women who become infected have been promised access to free HIV care and antiretroviral drugs.

Reference

Staff reports. AIDS: New trial shows needs for caution in adopting circumcision strategy. AFP/Yahoo. March 6, 2007.

http://news.yahoo.com/s/afp/20070306/hl_afp/healthaidscircumcision_070306192644&printer=1;_ylt=AqoQHs6S1ruZ6oIVWw2duIOKOrgF

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