----- Original Message -----
Sent: Friday, February 23, 2007 3:35
Subject: Circumcision’s Anti-AIDS Effect
Found Greater Than First Thought
Circumcision’s Anti-AIDS Effect Found Greater Than
By DONALD G. McNEIL Jr.
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
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
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
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
“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
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