Circumcision Doesn't Prevent Transmission of HIV to Women

Last March, I posed this question regarding circumcision: Is it better to snip or not? I described a new study that found that circumcised men were less likely to be infected with herpes and HPV and that moms should consider the health advantages of getting their infant sons circumcised. Boy, did that spark a heated debate! In the 100-plus comments posted, some folks called me "biased" in favor of circumcision, telling me that I overstated the findings of studies showing its benefits. Others strongly endorsed the procedure as an easy way to prevent infections in an area that's hard for young boys to keep clean.

A new study published in the Lancet will, I'm guessing, add more fuel to the fire. It found that circumcision of HIV-infected men does not reduce the rate of HIV transmission to their female partners.

From an American's point of view, the idea behind the study may sound unusual. But in areas of Africa where HIV infection rates are high, healthy adult men routinely get circumcised because research suggested it reduces their chances of being infected with the virus by 50 to 60 percent. The current study involving Ugandan men was designed to see whether circumcision could prevent the transmission of HIV by men who were already infected. What the researchers found was that 18 percent of the women whose infected partners underwent the procedure became infected with HIV during the two-year study, compared with 12 percent of women whose partners were infected but didn't get circumcised. The circumcised men may have had higher transmission rates, the researchers surmise, because some engaged in sex—against medical advice—before their surgery incision completely healed.

Both groups were advised to use condoms every time they had sex, but fewer than 10 percent in each group said they used condoms consistently. A significant 54 percent of the circumcised men and 40 percent of the uncircumcised ones said that they had never used condoms during the past year.

"One striking finding was the high rate of HIV transmission," researchers from the University of Washington write in the editorial accompanying the study. They point out that, in lieu of condoms, vaginal microbicides now being tested in Africa could cut the rate of transmission in couples at high risk—though research raises questions about whether some of these products could lead to treatment-resistant HIV strains. African women certainly need something they can use to avoid being infected, whether it's the female condom or a drug that kills the virus. It's time for them to take matters into their own hands.