Does Circumcision Prevent HIV?

Circumcision

Is circumcision a viable way to prevent HIV?  The short answer is “no.”  Only abstinence and safe sex have the ability to prevent the disease.  It does appear, however, that circumcision may reduce a man’s risk for contracting the disease.

A study published earlier this year on January 6, 2013 in the journal PLoS One found that there are changes in the penis’s microbiome – the community of bacteria that normally reside on the organ – after the foreskin has been removed.

The bacterial flora of the penis changes, they say, because the presence of the foreskin creates an anaerobic environment, allowing types of bacteria not requiring oxygen to grow.  When there is no foreskin to block out oxygen, the microbiome shifts to include more oxygen-loving bacteria.  The researchers believe that the presence of the anaerobic bacteria in uncircumcised men promotes inflammation and increases the odds that the HIV virus will cause an infection.

For the study, a reproductive epidemiologist at Johns Hopkins Bloomberg School of Public Health named Robert Gray worked with other scientists to compare the microbiota of 12 Ugandan men aged 15 to 49 before and after circumcision.  The men selected for the study were HIV-negative.  According to a co-author of the study, Lance Price, who is research director of the Translational Genomics Research Institute in Flagstaff, Arizona, it was important for the men to be HIV-negative since the virus itself would alter the microbiome.

Samples were collected between the head and shaft of the men’s penises both one year before and one year after they were circumcised.  Polymerase chain reaction analysis was performed on the samples in order to identify the types of bacteria in the samples, as well as how abundant they were.

When they analyzed the data, they found that the bacterial populations on the men’s penises had shifted from being primarily aerobic to being anaerobic after they were circumcised.

According to Gray, certain species of bacteria can create an inflammatory environment causing the release of  proteins which regulate immunity called cytokines.  These cytokines activate a type of immune cell called Langerhans cells.  This is significant in the transmission of HIV, he believes, because these activated Langerhans cells are the first cells to become infected by the virus.

The researchers also point out that after circumcision the skin on the penis become thicker, also helping to prevent HIV by reducing the number of Langerhans’s cells which are present.

Despite the fact that circumcision is not a complete preventative measure for HIV – studies indicate that may reduce infections by about 60% – the World Health Organization (WHO) does recommend it as an intervention in countries where there is epidemic HIV but fairly low levels of circumcision.

However, even if researchers can prove that circumcision helps to reduce the transmission of the HIV virus, it cannot be replied upon as the only strategy for preventing infections.  At best, it will only slow down the spread of the illness.  Other measures, such as educating men about the illness and its prevention through safe sex, are still necessary steps.

 

Op-ed

Written by:  Nancy Schimelpfening

 PLoS One

 

12 Responses to "Does Circumcision Prevent HIV?"

  1. Tommy124   September 28, 2013 at 1:22 pm

    Ronald Gray, why does anyone listen to him? He publishes with Brian Morris. Morris is a past member of circumfetishist groups, such as the Gilgal Society, and Circlist.
    Gray’s African study, one from which the famed 60% came, shows how not to conduct an ethical study. Evidence shows he was well aware of the other African studies, and controls were seriously lacking in all three.
    Even with this study, well, he doesn’t prove anything is wrong with having anaerobic bacteria, or even that it is unusual. He studied 12 people. May possibly cause an inflammatory reaction. Considering that more than 70% of the world’s males have their foreskins, and are not reporting trouble, does this study of 12 really make a difference?
    Have we learned anything we did not know before? Just the length to which Johns Hopkins will finance a meaningless study, which adds nothing to the sum of medical knowledge. And that 12 guys in Uganda got talked out of a healthy body part.

    Reply
  2. Ronald Goldman, Ph.D.   September 22, 2013 at 3:19 pm

    We cannot trust the World Health Organization on circumcision. The WHO circumcision “expert” promotes his own circumcision device, see http://www.kentecmedical.com/media/document/AccuCircWorkshopBrochure.pdf, a clear conflict of interest.

    Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. They have various flaws. The investigators did not seek to determine the source of the HIV infections during their studies. They assumed all infections were heterosexually transmitted. Most HIV infections in Africa are transmitted by contaminated injections and surgical procedures. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Authorities that cite the studies have other agendas including political and financial. There are millions of dollars involved in promoting and performing circumcisions. Research shows that circumcision causes physical, sexual, and psychological harm. Of course, this harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Please see http://www.circumcision.org/hiv.htm for more information and links to literature.

    Reply
  3. Ron Low   September 22, 2013 at 10:01 am

    Since we’re highlighting the work of Ronald Gray, let’s remember that in 2009 he published a controlled trial report about circumcising HIV+ Ugandans. Then men he cut infected their female partners 50% MORE often with deadly HIV than the men he left intact did.

    Reply
  4. Ron Low   September 22, 2013 at 9:57 am

    It’s very irresponsible to discuss the topic of ADULT VOLUNTARY circumcision to reduce STI risk and then show picture of baby being forcibly circumcised. Babies are not at risk for sexually transmitted infection. STI are irrelevant to the issue of forced childhood circumcision. Informed adults can decide for themselves about their own bodies.

    Reply
  5. Ronald Goldman, Ph.D.   September 21, 2013 at 5:25 am

    Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. They have various flaws. The investigators did not seek to determine the source of the HIV infections during their studies. They assumed all infections were heterosexually transmitted. Most HIV infections in Africa are transmitted by contaminated injections and surgical procedures. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Authorities that cite the studies have other agendas including political and financial. Research shows that circumcision causes physical, sexual, and psychological harm. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Please see http://www.circumcision.org/hiv.htm for more information and links to literature.

    Reply
  6. Tessa Tewksbury   September 21, 2013 at 4:58 am

    Male circumcision is not the HIV ‘vaccine’ we have been waiting for!
    “the 2005 survey data for Rwanda show an HIV-infection rate of 3.8% in circumcised men and only 2.7% in uncircumcised men. Data for Malawi in 2004 show a 13% HIV-infection rate in circumcised males, but a lower 9.5% infection rate in uncircumcised males. Clearly, circumcision status is not the only or determining factor in HIV prevalence patterns.”
    http://www.futuremedicine.com/doi/pdf/10.2217/17469600.2.3.193

    Reply
  7. Tessa Tewksbury   September 21, 2013 at 4:58 am

    Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV
    “Circumcision of infants or other minors has no place among HIV control measures in the Australian and New Zealand context; proposals such as these should be rejected.”
    http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2011.00761.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

    Reply
  8. Tessa Tewksbury   September 21, 2013 at 4:57 am

    HIV AND AIDS
    “There is no evidence that circumcision, whether in infancy, childhood, or adulthood, is effective in preventing heterosexual transmission in countries where HIV prevalence is much lower and routes of transmission are different, such as Europe and the United States. Sexually transmitted HIV infections in the West occur predominantly among men who have sex with men, and there is no evidence that circumcision offers any protection against HIV acquisition in this group.11,12
    The African findings are also not in linewith the fact that the United States combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The situation in most European countries is precisely the reverse: low circumcision rates combined with low HIV and STD rates. Therefore, other factors seem to play a more important role in the spread of HIV than circumcision status. This finding also suggests that there are alternative, less intrusive, and more effective ways of preventing HIV than circumcision, such as consistent use of ondoms, safe-sex programs, easy access to antiretroviral drugs, and clean needle programs.
    As with traditional STDs, sexual transmission of HIV occurs only in sexually active individuals. Consequently, from an HIV prevention perspective, if at all effective in a Western context, circumcision can wait until boys are old enough to engage in sexual relationships. Boys can decide for themselves, therefore, whether they want to get circumcised to obtain, at best, partial protection against HIV or rather remain genitally intact and adopt safe-sex practices that are far more effective.
    As with the other possible benefits, circumcision for HIV protection in Western countries fails to meet the criteria for preventive medicine: there is no strong evidence for effectiveness and other, more effective, and less intrusive means are available. There is also no compelling reason why the procedure should be performed long before sexual debut; sexually transmitted HIV infection is not a relevant threat to children.”
    http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf
    Human immunodeficiency virus infection in urban Rwanda
    “having an uncircumcised partner was not a significant risk factor for HIV infection”
    http://www.ncbi.nlm.nih.gov/pubmed/1886188

    Male Circumcision and HIV Prevention: Insufficient Evidence and Neglected External Validity
    “A comparison of male circumcision to condom use concluded that supplying free condoms is 95 times more cost effective.”
    http://atlc.org/Resources/Downloads/AJPMGreenetAl2010.pdf

    Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns
    “Condom use after male circumcision is essential for HIV prevention”. What is the purpose of male circumcision, if condom use is still needed to prevent sexual transmission of HIV?”
    http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

    Reply
  9. Rerun   September 21, 2013 at 3:42 am

    Cutting the complete dick will help prevent diseases in a much better way. It is unethical to propose circumcision when there are less invasive and better working solutions: use a condom.

    Reply
  10. Jhon Murdock   September 20, 2013 at 11:09 pm

    The urethra is where HIV gains entry: http://www.news-medical.net/news/20130301/Macrophages-allow-entry-of-HIV-in-the-urethra.aspx No point in foreskin amputation. Only a condom can protect the urethra.

    Reply
  11. Craig   September 20, 2013 at 9:55 pm

    Snip those foreskins!

    Reply
  12. Jack perry   September 20, 2013 at 9:05 pm

    Natural Men have natural bacteria. Cutmen have different bacteria, sometimes including staf A

    Reply

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