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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
Uncircumcised Men Have Higher HIV Risk - Study

October 10, 2003
Reuters (10.10.03) - Friday, October 10, 2003

Circumcised male patients had an eight-fold reduction in HIV-1 risk compared to uncircumcised patients in a study of 2,302 men at three STD clinics in Pune, India, released on Thursday. The incidence of diseases such as syphilis, gonorrhea and genital herpes was slightly higher among uncircumcised men, but the difference was not statistically significant.

The research, presented in San Diego at the 41st Annual Meeting of the Infectious Diseases Society of America, was part of a larger study investigating HIV infection risk at the clinics from 1993 to 2000. Demographics, sexual risk behaviors - including having sex with a prostitute - and condom use were similar between both circumcised and uncircumcised patients, said Dr. Steven Reynolds, one of the study's investigators.

Male circumcision - the removal of the foreskin that covers the tip of the penis - is typically done shortly after birth. Some two- thirds of US male infants are circumcised annually. Worldwide, the rates vary greatly, depending on culture and religion. In many countries, including India, circumcision is rare. The American Academy of Pediatrics no longer recommends routine circumcision because - despite some medical benefit - there can be complications.

Reynolds suggested that the inner surface of the foreskin does not have the same protective layer as the outside, and is potentially more vulnerable to HIV. "It is important that we offer measures to help curb the spread of AIDS, particularly in developing countries, where it continues to grow at an alarming rate," said Reynolds, a post-doctoral fellow at Johns Hopkins University School of Medicine.

Methods that uncircumcised men may be able to use to protect themselves against HIV include using condoms and, in the future, a potential topical microbicide that might be applied to the foreskin before sex, Reynolds said. "Circumcision as a potential prevention strategy requires confirmation by randomized clinical trials," Reynolds said. There are such trials now underway in Kenya, Uganda and South Africa. The presentation, LB-10, is titled "Male Circumcision Is Protective Against HIV-1 But Not Other Common Sexually Transmitted Infections in India."