French and South African AIDS researchers have called an early halt to a study of adult male circumcision to reduce HIV infection after initial results reportedly showed that men who had the procedure dramatically lowered their risk of contracting the virus.
The study's preliminary results, disclosed Tuesday by the Wall Street Journal, showed that circumcision reduced the risk of contracting HIV by 70 percent -- a level of protection far better than the 30 percent risk reduction set as a target for an AIDS vaccine.
According to the newspaper account, the study under way in Orange Farm township, South Africa, was stopped because the results were so favorable. It was deemed unethical to continue the trial after an early peek at data showed that the uncircumcised men were so much more likely to become infected.
All of the men in the study had been followed for a year, and half the men had been followed for the full 21 months called for in the original study design, according to the Wall Street Journal, which obtained a draft copy of the study. [...] Medical anthropologists began noticing as early as 1989 that the highest rates of HIV infection in Africa were occurring in regions of the continent where the predominant tribal or religious cultures did not practice circumcision. Adult HIV infection rates above 30 percent are found in Zimbabwe, Botswana, Swaziland and eastern South Africa, where circumcision is not practiced; yet HIV infection rates remain below 5 percent in West Africa and other parts of the continent where circumcision is commonplace.
Laboratory studies have found that the foreskin is rich in white blood cells, which are favored targets of HIV, the virus that causes AIDS. So the theory is that men who are uncircumcised are much more likely to contract the virus during sex with an infected woman, and that the epidemic spreads when these newly infected men have sex with other women within their network of sexual partners....
Allowing that the issues are somewhat different, it will be interesting to see if these results have a sort of follow-on effect outside Africa in Asia and in the West. I wonder if they'll have difficulties in some of the African countries as well, since circumcision can be used as a sort of tribal or religious marker.
It will be interesting as well to see if it results in an uptick in infant circumcision in Europe, where traditionally such things simply aren't done, except for religious reasons among Muslims and Jews and a few other very small groups. And here in the US, circumcision has been on a very very slow downslide after peaking in the 1960s. Historically, circumcision was performed because it would reduce masturbation by deliberately reducing the sensitivity of the penis (HA! like an old scar you didn't even remember getting and couldn't feel all that much would deter the youth of America!) and because ... it was thought to "reduce social disease", ironically enough. (Some people tend to compare male circumcision to female circumcision, also called female genital mutilation, which tends to make others discount what they say. After all, female circumcision is quite specifically designed to prevent those women from feeling pleasure in sex by excising significant parts of the vagina and entire clitoris -- if you don't enjoy sex, you're not going to be unfaithful, are you? -- as well as the same sort of tribal and religious markers as male circumcision. The problem is, of course, that female circumcision tends to also carry with it not only a specific mutilatory intent absent from male circumcision, but also a much higher incidence of infection and death. But I digress.)
One possible reason for the reduction in the US circumcision rate is because people pointed out that there was, shall we say, quite clear evidence that circumcision didn't reduce masturbation, that there seemed to be no evidence whatsoever that it reduced disease, and that it inflicted pain on an infant -- typically, no anaesthetic is given during the brief surgery -- for no apparent reason whatsoever. (Peculiarly, in the United States, while the Northeast has had the highest rate of circumcision -- approximately 65-70% of all males -- the West, even today, has a sharply lower rate, approximately 30-45% over the years. A reflection of fewer hospitals and a different ethnic mix, perhaps.) Now that we have evidence that it does reduce disease, will that rate increase?
Another question that I wonder about -- and one that these studies could answer, if they're properly set up -- is whether or not circumcision might significantly reduce the rate of transmission of other diseases. After all, if it works for one, it might work for the others.
There are organizations in this country working to reduce the circumcision rate, viewing it as a form of both unanesthetized and painful surgery -- which it is -- and genital mutilation -- which, within a very strict definition of the word "mutilation", it might be. This argument is both that it's torture for the infant, and that it interferes with the sexual sensation of men. So the question for some parents may become: even allowing that all of this is true (and the jury is still somewhat out on the latter issue, if not the former) ... is it worth the reduced risk?
The question in Asia and Africa may be: is it worth taking on a primary marker of another ethnic group or religious group -- one you may have some reasons to dislike -- to reduce the risk of contracting HIV?Posted by iain at July 06, 2005 01:21 PM