Circumcision’s Anti-AIDS Effect Found Greater Than First Thought

Circumcision may provide even more protection against AIDS than was  
realized when two clinical trials in Africa were stopped two months  
ago because the results were so clear, according to studies being  
published today.

The trials, in Kenya and Uganda, were stopped early by the National  
Institutes of Health, which was paying for them, because it was  
apparent that circumcision reduced a man’s risk of contracting AIDS  
from heterosexual sex by about half. It would have been unethical to  
continue without offering circumcision to all 8,000 men in the  
trials, federal health officials said.

That decision, announced on Dec. 13, made headlines around the world  
and led the two largest funds for fighting AIDS to say they would  
consider paying for circumcisions in high-risk countries. But the  
final data from the trials, to be published today in the British  
medical journal The Lancet, suggest that circumcision reduces a man’s  
risk by as much as 65 percent.

The December announcement described only the follow-up on the men as  
originally divided into two groups: those who agreed to be  
circumcised and those who agreed not to. But some in the first group  
never went to the circumcision clinic, and some in the second had  
private circumcisions before the study ended.

Re-evaluating the data, excluding a few men whose H.I.V. status was  
misdiagnosed during the trial and combining the results of three  
trials — those in Uganda and Kenya as well as one in South Africa  
that was stopped in 2005 when the protective effect became apparent —  
produces a protection rate of about 65 percent.

Dr. Anthony S. Fauci, director of the National Institute of Allergy  
and Infectious Diseases, which paid for the trials, said he planned  
to keep saying officially that circumcision cuts a man’s risk by  
about half, not by 65 percent, because the validity of clinical  
trials depends on following randomized groups of patients, not  
selected ones.

“But, yes, the 65 percent makes me feel better,” he conceded.

“Look,” he added. “This is a one-time, permanent intervention that’s  
safe when done under the appropriate medical conditions. If we had an  
AIDS vaccine that was performing as well as this, it would be the  
talk of the town.”

He said President Bush’s $15 billion AIDS initiative and the World  
Health Organization were considering paying for circumcisions in high- 
risk countries, but must work out what training and equipment they  
would require circumcisers to have.

Daniel Halperin, an AIDS expert at the Harvard Center for Population  
and Development, noted that the world’s highest rates of infection  
with H.I.V., the virus that causes AIDS, are in southern African  
countries like Botswana, Swaziland and South Africa, which are  
relatively wealthy by African standards and the best prepared to  
offer safe circumcisions in public hospitals.

Acceptance of circumcision is growing among African men, Dr. Halperin  
said. Muslims in East and West Africa have long practiced it, as have  
some ethnic groups.

A review of 13 surveys in different African communities published  
last year in the journal AIDS and Behavior found that 29 percent to  
87 percent of uncircumcised men said they would be willing to be  
circumcised if it protected them against AIDS.


Copyright 2007 The New York Times Company

s. e. anderson (author of "The Black Holocaust for Beginners" -  
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