Circumcising HIV-infected men may spread virus

March 09, 2007|By Jonathan Bor | Jonathan Bor,SUN REPORTER

Circumcising HIV-infected men to prevent them from spreading the virus to their female partners might have the opposite effect, according to preliminary results of a study in Uganda by the Johns Hopkins Bloomberg School of Public Health.

Scientists found that infected men who resumed sexual activity before their circumcision wounds healed were more likely to spread the virus than infected men who didn't have the surgery.

"This is a complicated situation ... but it seems that HIV-positive men initiating sex before wound healing is potentially dangerous for transmitting HIV," said Dr. Kevin M. De Cock, head of the World Health Organization's HIV/AIDS department.

The results of the research so far are not statistically significant, scientists noted. Also, they said the findings do nothing to discredit an earlier study that showed circumcising uninfected men reduced their chances of becoming infected by 50 percent to 60 percent.

Yet researchers said they must approach with caution the idea that circumcision could make sex between an infected man and his partner less risky. They spoke this week at a teleconference during an international meeting in Montreux, Switzerland.

Public health leaders from around the world are gathering there to consider the role that adult circumcision might play in the battle against AIDS, particularly in hard-hit southern Africa. The meeting is sponsored by the WHO and UNAIDS, a program of the United Nations.

Increasing numbers of adult men in Uganda and Swaziland have decided to have the surgical procedure since scientists announced in December that circumcision drastically reduced a man's chance of becoming infected.

In the second study, 70 infected men had healthy partners at the time of their circumcision. Among these couples, 11 men transmitted the virus to the women over the course of two years after their surgery.

A control group of 54 uncircumcised men showed better results: Only four of the women became infected.

"These numbers are very small, and they could have arisen by chance alone," said Dr. Maria J. Wawer, a professor at Bloomberg and the study's principal investigator. "It's impossible to draw a firm conclusion."

Moreover, the study also found that most of the circumcised men who infected their partners had resumed sex before their wounds healed, despite warnings.

De Cock said those men might have exposed their partners to virus lurking in surgical wounds or in tears that occur during intercourse.

Scientists say they believe that circumcision protects men from becoming infected, because the foreskin - removed during the surgical procedure - contains millions of cells targeted by the AIDS virus.

Similarly, they speculate that circumcising infected men could protect women by reducing their exposure to viral particles. Still, circumcising infected men would not completely protect women, because ejaculate also contains virus, the scientists said yesterday.

Despite enthusiasm over the potential of circumcision to curb the epidemic, public health officials say men must take precautions such as practicing abstinence or wearing condoms.

Dr. David Serwadda, principal investigator from the Rakai Health Sciences Program in Uganda, said circumcision will remain a powerful weapon against AIDS even if further analysis shows that circumcising infected men does not protect their partners.

"Eighty to 90 percent of sexually active men are negative," said Serwadda. "The importance of the trial in HIV-negative men still applies to the majority of men who are sexually active in Africa."

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