Uncircumcised Indian men have 8 times higher HIV risk

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Uncircumcised Indian men have 8 times higher HIV risk

Uncircumcised men have an eight fold higher risk of becoming infected

with HIV compared to circumcised men, according to a study of 2298

Indian men presented on Thursday at the 41st Annual Meeting of the

Infectious Diseases Society of America by Dr Reynolds of s

Hopkins University, Baltimore.

The research was part of a larger study investigating risk factors

for HIV-1 infection based on men attending one of three STD clinics

in Pune, India. Between 1993 and 2000, 2,298 men who tested negative

for HIV-1 were enrolled in the study. During subsequent visits (an

average of three visits in 11 months), 2 of 191 men who were

circumcised and 165 of 2,107 who were uncircumcised tested positive

for HIV.

Demographics, sexual risk behaviours (including having sex with a

prostitute), and condom use were remarkably similar between both

groups, said Dr. Reynolds. Despite the similarity in risk profiles,

researchers determined the incidence rate of HIV-1 among circumcised

men it was 0.7 percent, whereas among uncircumcised men it was 5.5

percent, an 8-fold increase. The relative risk of infection among

circumcised men, after adjusting for calendar year, age group, level

of education, marital status, living with family, multiple sex

partners, sex worker partners, condom use, tattoos, and medical

injections, was 0.12 (p=0.003).

However, the study did not find circumcision to be protective against

other sexually transmitted diseases, including syphilis, genital

herpes and gonorrhoea.

The findings suggest the benefit of circumcision may be biological

rather than due to other factors, such as differences in behavior

between circumcised and uncircumcised men, or the possibility that

circumcision promotes the acquisition of sexually transmitted

infections, said Dr. Reynolds. The inner surface of the foreskin is

not as thickly " keratinised " as the outside or other surfaces of the

penis, meaning it has less of a protective layer and may be more

easily penetrated by HIV, he said. It also has higher numbers of the

cells that HIV infects, possibly contributing to the reduced risk of

HIV infection observed when the foreskin is removed.

There are other potential methods uncircumcised men may be able to

use to protect themselves against HIV, said Dr. Reynolds. In the

future, a topical microbicide product might be applied to the

foreskin before sex to protect against HIV. Such products are

currently in development.

Circumcision isn't totally protective and may not be culturally

acceptable or safe in some settings, so regular condom use is still

the best way of protecting against HIV and other sexually transmitted

diseases, said Dr. Reynolds. Condom promotion remains a key strategy

in the current fight against the spread of AIDS, he said.

" Circumcision as a potential prevention strategy requires

confirmation by randomised clinical trials, which are the gold

standard in evaluating medical interventions, " he said. There

currently are clinical trials underway in Uganda, Kenya and South

Africa.

Reference

Reynolds SJ et al. Male circumcision is protective against HIV-1 but

not other common sexually transmitted infections in India. 41st

Annual Conference of the Infectious Diseases Society of America, San

Diego, 2003.

http://www.aidsmap.com/news/newsdisplay2.asp?newsId=2350

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[The following is the reply for a request for furhter details of this study.

Moderator]

___________________

Dear Mr. ,

With regard to the article, Uncircumcised Indian men have 8 times higher HIV

risk, it has not been published and was presented at the IDSA meeting last week.

We will not be releasing further details prior to publication.

We may be able to provide more information after its publication.

Thank you,

Debra L. Gair

Senior Administrative Assistant

s Hopkins School of Medicine

Division of Infectious Diseases

1830 E. Monument Street, Room 458

Baltimore, MD 21287-0003

(443)287-4098-Ph (443)287-6440-Fax

dgair1@...

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