Posted by: davidjolson | 07/22/2011

Male circumcision curbs spread of HIV over time, risky behavior does not increase

A slide from Dr. Auvert showing what would have happened without MC intervention on all adult men in the Orange Farm community in South Africa.

This is a guest blog by Meredith Mazzotta of Science Speaks, the blog of the Center for Global Health Policy.

ROME  — Three years after the voluntary medical male circumcision (MC) campaign rolled out in the Orange Farm Township in South Africa, the first “real world” results are available showing a marked reduction of HIV acquisition among circumcised adult men with a 55% lower HIV prevalence (proportion of HIV-infected people) among circumcised men compared to their uncircumcised counterparts and overall reduction in HIV incidence (the number of new cases) among men 15 to 34 years old of 76%.

Earlier randomized controlled studies have shown medical male circumcision to reduce the risk of men acquiring HIV through vaginal sex by up to 60%. It is rare indeed for on-the-ground implementation of an intervention to yield even greater efficacy than was measured in a randomized clinical trial.

Earlier randomized controlled studies have show medical male circumcision to reduce the risk of men acquiring HIV through vaginal sex by up to 60%.

The ANRS 12126 trial involved 110,000 adults and shows MC roll-out is effective at the community level in curbing the spread of HIV. The free service was offered to all willing male residents 16 years of age and older.

“After three years of this project, people are still coming to us to get circumcised,” said Dr. Betran Auvert of the University of Versailles, principal investigator of the ANRS trial. When the trial started, circumcision prevalence among men in Orange Farm was at 10%; now it is 50%, and even higher among young people, he said at a press conference Wednesday afternoon at the 2011 International AIDS Society Conference.

“We calculated that without MC in this community HIV prevalence would have been 25% higher and without MC in this community HIV incidence among all men would have been 58% higher,” Auvert said at the late-breaker session

Also crucially important, men are not changing their sexual risk behavior after having been circumcised, Auvert said. Circumcised men were found to be younger, more educated, less likely to be married and more aware of their HIV status than those who were not circumcised.

Another MC study with results reported at the conference revealed that of 316 men interviewed one year after having been voluntarily circumcised, 92.3% said they experienced more sexual pleasure after the operation and 87.7 % found it easier to reach an orgasm. The researchers at the University of Makerere in Uganda also revealed that nine out of 10 men said they were happy with the look of their penis after having the operation, and 95.4% said their partner was also pleased.


Responses

  1. Both of these studies were carried out by researchers who have long had an interest in promoting circumcision. Both were presentations, not peer-reviewed papers.

    Auvert et al. found in the same place (Orange Farm) in 2001 that circumcision in its usual cultural context showed no protective effect, suggesting that it is something else about the intervention that makes the difference.

    The circumcised men were younger, more educated, and more aware of their HIV status than those who were not circumcised. That in itself may hold the explanation for the lower HIV rate, and nothing to do with circumcision. Being younger, they have had less opportunity to be infected. Being more educated, they may be more careful (as also shown by
    their greater awareness of their status). They all volunteered for circumcision, so they might be more careful anyway.

    Large percentages (like “76”) may look impressive, but they can hide a slight reduction, from very rare, to very very rare. What are the actual figures, and how were they determined?

    We should be very wary of the beguiling claim that circumcision itself is protective, after its sorry history as a “cure” in search of a disease, an intervention in search of an excuse.

    Bailey et.al.’s study of sexual satisfaction could not by its nature be double-blinded, and everyone involved knew the “right” answers, so its statistics are of low value if any. Since the men in this study too had volunteered to be circumcised, the selection of subjects was already biased. Men who valued their foreskins would not take part.


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