American research bodies have called an early halt to trials of adult male circumcision in Kenya and Uganda after results showed that men who had undergone the procedure dramatically lowered their risk of contracting the HI virus.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), announced an early end to two clinical trials of adult male circumcision after an interim review of the data revealed that medically performed circumcision significantly reduced a man’s risk of acquiring HIV from having heterosexual intercourse.
The trial involving almost 3,000 HIV-negative men in Kisumu, in the western highlands of Kenya, showed a 53 percent reduction in contracting HIV among those who were circumcised, while a trial with about 5,000 HIV-negative men in the Rakai District of central Uganda showed that HIV acquisition fell by 48 percent in circumcised men.
“These findings are of great interest to public health policy-makers who are developing and implementing comprehensive HIV prevention programmes,” said NIH Director Dr Elias Zerhouni in a statement. “Male circumcision, performed safely in a medical environment, complements other HIV prevention strategies and could lessen the burden of HIV/AIDS, especially in countries in sub-Saharan Africa where, according to the 2006 estimates from UNAIDS, 2.8 million new infections occurred in a single year.”
This confirmed research conducted last year by a team of French and South African scientists, who found that circumcision appeared to reduce the chances of HIV infection in such men by up to 60 percent. So dramatic was the protective effect that the South African trial was also stopped early because it was considered unethical not to offer the uncircumcised men in the control group the chance to have the operation immediately.
More than 30 studies around the world have suggested that circumcision can protect men from HIV to some degree, but the South African trial was the first randomised, controlled study to demonstrate the extent of protection.
After calls for safe male circumcision to be integrated into national HIV-prevention strategies, several African countries have acted on the results of the South African-based study: Zambia and Swaziland both launched national male circumcision programmes, while a report by the 14-member Southern African Development Community described male circumcision as “a one-off intervention conferring lifelong reduced biological risk”. Other countries, including South Africa, have delayed action until the results of the study in Kenya and Uganda were available.
NIAID has warned that this does not mean circumcision alone can prevent men from becoming infected with HIV during sexual intercourse, emphasising that “circumcision is only part of a broader HIV prevention strategy that includes limiting the number of sexual partners and using condoms during intercourse”.