The preliminary results from two major trials in Kenya and Uganda of around 8,000 men show that medical circumcision of men reduces their risk of acquiring HIV during heterosexual intercourse by 53 percent. It supports a previous South African study, which showed a 60 per cent reduction in HIV infection among circumcised men.
The US National Institutes of Health announced its decision to end the study early in light of the striking findings.
Kwango Agot of the University of Nairobi, Kenya, a senior programme officer at the study centre, explained that uncircumcised men are at higher risk of contracting HIV because the foreskin is rich in sentinel cells of the immune system and attach easily to HIV. "The foreskin sometimes ruptures during intercourse."
In response to the media reports, The New Zealand AIDS Foundation (NZAF) was quick to point out that the results does not mean that circumcised gay and bisexual men are only half as likely to get infected with HIV.
Five top United Nations agencies - the World Health Organization, UN Population Fund, Joint UN Programme on HIV/AIDS (UNAIDS), UN Children's Fund and the World Bank - have also cautioned that despite the findings, urging people to continue using condoms during sexual intercourse.
"Circumcised men can still become infected with the virus and, if HIV-positive, can infect their sexual partners," said a joint statement.
It added that circumcision should never replace other known, effective preventive methods and should be considered as part of a comprehensive prevention package.
Eamonn Smythe, NZAF Acting Executive Director, was quoted in GayNZ.com as saying, "There is no evidence to suggest that circumcision prevents the spread of HIV through unprotected anal sex, which is the most common method of transmission between men in New Zealand."
"The anus lining has a dense collection of cells that act as receptors for HIV, which are spread across a much greater surface area than the foreskin," Smythe said. "The great majority of gay and bisexual men with HIV in New Zealand are likely to have become infected through the lining of the anus."
Smythe also discourages gay men who are considering circumcision as a substitute for using condoms as little research has been done about the correlation between circumcision and HIV infection via anal sex, stressing that the best prevention against HIV for gay and bisexual men are still condoms.
Next page, what is circumcision?
What is circumcision?
Source: Gayhealth.com
Circumcision is a surgical procedure that removes your foreskin (the folds of skin around the head of your penis, or glans). Newborns, children, adolescents and adults alike get circumcised, for several reasons: religious, aesthetic, because foreskin is uncomfortably tight and difficult to retract (phimosis) and for cleanliness - some people think a circumcised penis is easier to keep clean and free from infections including sexually transmitted diseases (STDs) and balanitis. Others, however, are opposed to the procedure, arguing that circumcision is medically unnecessary and, in the case of newborns, a cruel application of pain. Indeed, the issue of circumcision is a contentious one.
Around sixty percent of American men are circumcised, whereas most men from Latin America, Asia and Europe are not. Circumcision of males is a religious requirement of the Jewish and Muslim and faiths and as a result is practised extensively throughout the Middle East, North Africa, Malaysia and Indonesia.
How is it done?
For adult males, the operation typically takes about 30 to 45 minutes and is performed under local anaesthesia. No hospitalisation is required. Most men recover in three weeks. Minor complications such as swelling, bleeding, pain and infection may occur after the operation.
Important considerations
Once you get circumcised, you can kiss that foreskin goodbye - there's no good way to undo the procedure! Some men advocate non-surgical foreskin restoration, in which the remaining skin on shaft of the penis is, over time, stretched over the head of the penis to create a hood of skin that resembles foreskin. Remember, this is not the same as having original foreskin, and you should not undergo this restoration without consulting your doctor first. Other surgical procedures try to create a flap of skin to cover your glans. They often result in a loss of sensation and scarring.
Some men who've been circumcised as adults report that the glans (the head of the penis) becomes less sensitive after surgery.
Keep in mind, there are varying degrees of circumcision: some men who've been circumcised still have a fair amount of foreskin. Their penises may even look intact!
Researchers from Australia reported on June 9, 2000 that circumcision may provide protection against HIV and STDs. The inner surface of the foreskin contains HIV receptors, which are susceptible to the virus and other infections, the researchers say. By removing the foreskin, many of these receptors are removed, which may help protect you. Even so, all men should always use condoms to help ensure their safety from disease.
One last thing: don't get pressured into getting circumcised. It's your body and your choice. If your boyfriend pushes you to have the procedure, maybe he's the one who should speak to a doctor!
Possible side effects
While you heal, the area around the incision may be swollen and painful; your doctor may recommend ice-packs to bring down the swelling and prescribe medication to control the pain.
Dangerous complications
Circumcision, no matter at what age, is considered a safe and routine procedure. All surgeries, however, carry risks for bleeding and infection, and an adverse reaction to anesthesia. As always, choose an experienced physician to perform the procedure. If done incorrectly, your penis can be injured if too much skin is removed. In rare instances, a separation of the incision can also occur.
Newborns who are circumcised may hemorrhage from the procedure, but this is "rare," says Harry Fisch, M.D., Director of the Center for Reproductive Health at Columbia Presbyterian Medical Center.
How long is the healing process?
Healing time for newborns takes about one week. Some swelling and formation of yellow crust around the incision area is normal. If you are circumcised after infancy, healing can take up to three weeks. During this time vigorous exercise and sex should be avoided. Be sure to follow your surgeon's instructions on proper care of the wound, and contact him or her immediately if your entire penis looks swollen and red, if fresh bleeding occurs after surgery, or if pus drains from the incision.
How do you reverse it?
Once your foreskin is removed, there is no good way to restore it. Some fans of foreskin advocate non-surgical foreskin restoration, in which the remaining skin on the shaft of the penis is stretched, over time, to create a retractable hood of skin that resembles foreskin. This is not a replacement for original foreskin, and you should consult your doctor before trying this procedure.
Other surgical procedures try to create a flap of skin, resembling original foreskin, to cover your glans. Beware! They often result in loss of sensation and scarring.
How much does it cost?
As a guide, The Family Planning Association of Hong Kong performs the procedure at its Wanchai Clinic. Circumcision operation for males aged 18 years or above is performed under local anesthesia in our operating theatre in Wanchai and the operation fee is HK$3,000. Wanchai Clinic at 27119656 or Ma Tau Chung Clinic at 21920202
In Singapore, the Singapore General Hospital (Urology Centre or Department of General Surgery) charges about S$570 or S$220 through a Polyclinic referral. Central Appointments: 6321 4377
Readers elsewhere should check with their GP or local hospital.
讀者回應
If circumcision really did protect against HIV then the USA, with the vast majority of its men being circumcised, would have one of the lowest rates of HIV infection in the (western) world. Of course the opposite is true.
Of course these studies may, in fact, merely show that those men whose penises have been surgically diminished have less sex than those with fully-functioning members (and thus less potential exposure to HIV) or, indeed since they focus on sub-Saharan Africa that the adherants of Christianity and traditional religions in Africa are less morally bound by religious proscriptions about sex than their Muslim neighbours.
In any case, we need to be wary of irresponsible headlines (sadly such as the one above - 'male circumcision reduces HIV risk in half') when in fact, as the article points out, this isn't true for gay or bi-sexual men and moreover, halving the risk is pointless ... it has to be eliminated by wearing a condom. The last thing we need is cut men thinking that they're imune from any disease because of having a surgically diminished penis. It just isn't so.
All circumcision ensures is a penis that doesn't work properly.
Along the same line, circumcised men should not take this study as conclusive proof that they are "invulnerable" and immune to the HIV virus, become complacent, and start/continue practising unsafe sex....
It is not a waste of time to conduct a study like this because almost nothing has a direct 1 to 1 correlation. Consider any medical study or for that matter, economic study.
To drelin, making wild allegation based on nothing is rather spurious. And even though the Bush admistration has promoted abstinence programs in Africa and the expense of condoms, (I am citing the Economist magazine 3 weeks ago) rates of HIV infection have decreased due to their actions since people are having sex later in life.
Just because something has been shown to cut down the risk of HIV transmission does not mean it is a cureall, nor does it mean any of us have to get defensive and start deriding the science behind it.
So what if the foreskin has been shown to be more receptive to HIV? We have always known that unprotected sex puts the insertive partner at risk - now we know one of the factors that may put him *more* at risk. Doesn't mean that being circumcised makes him invicible...
What's more interesting to me in this situation is the reaction of the readers to the news - the suspicion, doubt, denial, willingness to downplay the findings simply out of denial and no corroborating data, etc.
Sure be cynical. Everyone has a right to question. But if you read the article, and indeed the NIH findings accurately, no one is saying - go get a *snip* job and let's be done with them pesky condoms (and foreskin). In fact, they acknowledge that in Africa, circumcision is more costly and difficult to come by (consider the access to hydienic surgical procedures)....
BUT when a study has been shown, even at half point, to have such a profound and statistically significant impact, then it becomes unethical to continue the study and deny the participants in the control group from "treatment". It doesn't matter if it's a pharmaceutical or a surgical intervention - ethics is ethics.
So boys - it remains a patent fact that unprotected sex puts you at risk for HIV. Now we know a little more about which unprotected tops may be more at risk (but the study was not conducted amongst MSM, and it is unlikely that it would ever be - it is unethical to advocate unprotected anal sex between gay men to compare between circumcised and uncircumsised, even for a medical study), but it doesn't change the fact that BOTH partners are at risk.
When having what is currently defined by the in-the-know scientific community as risk-related sex, always use condoms. (100% of the time).
Is that too simple for the snobish esoteric community to grasp??
Whether we agree or not with the informative value, or validity of the research leading to the published statistics on circumcision (whether new news, or old) is hardly important.
Saving lives is important.
It is important to protect our own lives and the lives of our sex partners. It's really quite simple (USE CONDOMS) and doesn't depend at all on expensive research projects which appear to identify significant, interesting correlations.
As one who has earned his PHD in Psychology and has conducted his own share of statistical analyses the past 20 years, I can, with a high degree of studied and practical knowledge and authority state that the circumcision correlation to HIV is merely a remarkable example of psychological/mental masterbation .
1. It only relates to female to male transmission. This does nothing to protect women and passive male partners from men who think they've got some magical protection and don't use comdoms
2. Good hygiene (soap and water) plus proper condom use cuts ALL HIV transmission to nearly zero.
3. The rate of transmission quoted in the study is so low that halving only offers marginal protection compared to condoms.
4. Headlines like this only serve to create more HIV infections and reduce 100% condom use campaigns.
5. Why the hell were test subjects allowed to infect themselves and others when simple use of condoms would have protected them?
6. Circumcision does NOT protect men from sexually transmitted diseases which in turn can make them more liable to get infected from HIV.
Wise up and use a condom. You don't need to cut off part of your penis to play safely.
By the way, a new study has shown that removal of both testicles can result in a 100% reduction in testicular cancer.
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