New Study on HIV Transmission

A story that aired this morning on the BBC grabbed my attention.

The lead-in stated enthusiastically that, “… a tremendous breakthrough has been made in the war against HIV … ” so I sat down and waited for the story to air, hoping … well, hoping.

It seems two studies funded by the US National Institutes of Health have come up with dramatic evidence indicating that circumcision cuts the rate of HIV infection in heterosexual men by 50%.

Circumcision is historically a huge issue in internationally adoptive families, as our boys come to us at all ages and parents go through contortions trying to do the right thing. It may be, though, that there are much more compelling reasons for circumcising our sons than whether or not they’ll wonder about being different from their dads and the other boys in the locker room.

Apparently, certain cells that live under the foreskin are especially welcoming to the HIV virus. This, combined with the toughening up the skin there gets after circumcision that keeps the chance of bleeding down, is thought to be the reason for the drop in infection rates in circumcised men.

It’s been noticed for years that circumcised men were represented in smaller numbers of the HIV+, but there have been questions about possible lifestyle impacts. Now it looks as though it’s a physical thing.

The results of the studies were so overwhelming that the NIH stopped the trials due to ethical concerns.

The two trials of around 8,000 men took place in Uganda and Kenya were due to finish in July and September 2007 respectively.

But after an interim review of the data by the NIH Data and Safety Monitoring Board decided to halt the trials as it was unethical not to offer circumcision in the men who were acting as controls.

I’m not alone in concerns that some may think circumcision will provide some sort of magical protection against AIDS. If this happens and circumcised men feel they can do what they want, when they want, with whomever they want … well, it won’t help much, will it?

Dr Kevin De Cock, director of the HIV/Aids department of the World Health Organization told the BBC the results were a “significant scientific advance” but were not a magic bullet and would never replace existing prevention strategies.

“We will have to convene a meeting which we hope will happen quite soon to review the data in more detail and have discussions about the implications.

“This is an intervention that must be embedded with all the other interventions and precautions we have. Men must not consider themselves protected. It’s a very important intervention to add to our prevention armamentarium.”

I also worry that a spate of these surgeries may take a toll. Although routine and fairly simple, no operation is without risk, and a giant leap in the number of circumcisions, especially if many are conducted under less than prime conditions, could result in deaths.

It was a five-year-old getting his bits done on the BBC this morning … not the target group for an immediate chop … so I’m assuming there’s already a knee-jerk response to the news in action.

If this works, and works well, however, the drop in infections could be very impressive:

A modelling study done by international Aids experts earlier this year showed that male circumcision could avert about six million HIV infections and three million deaths in sub-Saharan Africa.

The results of a study now taking place assessing the risk of transmission to women in Uganda is due in 2008.

I know. I know. This is going to be SO flippant and irreverent, but I just can’t end this post without commenting on the fact that the doctor quoted happens to be named Kevin De Cock. Really …. is it just me?

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