HIV infection risk reduced for Circumcised Heterosexual Men in Kenya

HIV infection risk reduced for Circumcised Heterosexual Men in Kenya

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A study from the University of Illinois at Chicago found that circumcised males that had heterosexual intercourse in Kenya, had a 53 percent less chance of acquiring the HIV infection. The study was stopped early because of preliminary results of infection rates, and during a Data Safety and Monitoring Board met Dec. 12th, they asked for the National Institutes of Health to stop the trial and have all the men that are uncircumcised that are currently participating in the trial to be offered circumcision.

"Circumcision is now a proven, effective prevention strategy to reduce HIV infections in men," said Robert Bailey, professor of epidemiology in the UIC School of Public Health and principal investigator of the study.

The study was funded by the National Institute of Allergy and Infectious Diseases and the Canadian Institute of Health Research. There were a total of 2,784 male participants from Kisumu, Kenya who ranged in age from 18 to 24 years old that were tested negative for have HIV and were uncircumcised. Half of the men were assigned to be circumcised. The other have remained uncircumcised.

All of the men that participated received for 24 months, free HIV tests, counseling, medical care, tests, and treatments for any sexually transmitted infections. They were also provided condoms and behavioral risk counseling.

The preliminary results showed that 22 of the 1,393 circumcised men had contracted the HIV virus, compared to 47 of the 1,391 uncircumcised men becoming infected. This infection rate reflects 53 percent fewer cases of HIV infections in the circumcised men.

"With these findings, the evidence is now available for donor and normative agencies, like WHO and UNAIDS, to actively promote circumcision in a safe context and along with other HIV prevention strategies," Bailey said.

"Circumcision cannot be a stand-alone intervention. It has to be integrated with all the other things that we do to prevent new HIV infections, such as treating sexual transmitted diseases and providing condoms and behavioral counseling," Bailey said. "We can't expect to just cut off a foreskin and have the guy go on his merry way without additional tools to fight against getting infected."

One concern is that circumcised men may feel falsely secure that they will not get HIV and may be more likely to participate in risky behavior. This study shows that it did not increase the risky behavior in the circumcised men.

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"Both uncircumcised and circumcised men are reducing their sexual risk behavior," he said, "which indicates that our counseling is doing some good."

There were no severe long lasting complications from the circumcisions. There was 1.7 percent that suffered bleeding or infection from the surgical procedure.

"Already, there are large numbers of boys and young men who are seeking circumcision in areas of Africa where men are not traditionally circumcised," he said. "The danger is that unqualified practitioners will fill a niche by providing circumcision, but with much higher complication rates."

The estimates for HIV/AIDs infection is around 30 million people in Africa. HIV infection in adults is 90 percent of the time with heterosexual intercourse. In Kisumu, there are an estimated 26 percent of uncircumcised men that are infected with HIV by the age of 25.

"This study will likely not have a large impact on the incidence of HIV/AIDS in the United States or Europe where heterosexual transmission of HIV is low compared with areas like sub-Saharan Africa and parts of Asia," Bailey said. "However, there are other proven health benefits of circumcision, including better hygiene, fewer urinary tract infections, and less risk of cervical cancer in the partners of circumcised men."

By Mark Barone
Best Syndication Health Staff Writer



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